December 2017 No Images? Click here Continuity of careQ and A with Anne O’Connor, practice manager and practice nurse from Windmill Practice, Tamworth. Windmill Practice started Health Care Homes in October 2017. Why did your practice sign up? “We’re a new practice. We’re been open for four years and our motto is continuity of care. Continuity of care and planned care for patients with chronic disease makes sense, so the framework of Health Care Homes fits in nicely with that.” How many patients have you enrolled? “We have registered 20 patients under two of our GPs, Dr Louise Badenhorst and Dr Heather Carr. “We got the systems in place and the risk stratification tool up and running prior to commencing the registration process. The tool is now working well and is very simple to use.” Will you have a gradual on-boarding of patients from now? “Yes. We will do it on an ad-hoc basis, at least until the end of the year. As patients come in, we will have a conversation with them and may suggest that they are suitable to be enrolled in the program. “We also have our diabetes register up-to-date now, so we will look at targeting some individuals as well. We plan to adopt a more targeted approach in the new year.” What are your fees for Health Care Home patients? “We’re a private billing practice and some of our Health Care Home patients will be charged a private gap fee. However we have set our fees so that neither patients nor doctors will be financially disadvantaged.” How are you keeping in touch with your Health Care Homes patients? “The practice has brought a medical assistant on board and we’ve come up with a spreadsheet to collate and monitor co-ordination of care for our Health Care Homes patients. “Our medical assistant is responsible for entering the data when a patient is enrolled, finding out when their next planned care is, and if they didn’t have a recent care plan, organising to get it done. “Our clinical team works very collaboratively and co-operatively. Our practice nurses will have a coordinating role for the health care home patients. In consultation with the treating GP, they will organise the planning and coordination of care." Now that you’ve got your systems up and running and some of your patients enrolled, have you changed the way you do some things? “We were doing a lot of planned and co-ordinated care already. However, participating in Health Care Homes has nudged us into making our systems more robust, and our planning more methodical, which is a good thing. The program is also allowing us to think about more creative ways of doing things to improve health outcomes for our patients. “Some of our patients have mentioned that they find exercising on their own difficult and that costs associated with exercise can be prohibitive. We are planning to start a walking group to support our patients to become more active and the medical assistant is going to be in charge of taking the group, twice a week. “To not be bound by fee-for-service and face-to-face contact for service provision is very different. It will take everyone a little while to get their head around that. Change can be a bit daunting, but also very exciting. “We are still in the early days. However we are pleased with the progress we have made so far and looking forward to developing new strategies and adjuncts to care. If Health Care Homes gets rolled out further, I believe that we really need to do much more work on prevention. The importance of prevention for chronic disease and the promotion of health and well-being is not being heard well enough. Our future direction needs to be more about health and less about illness.” Below: Dr Louise Badenhorst (left) and Anne O’Connor. Photo courtesy of Windmill Practice. New resourcesThe Health Care Homes' practice handbook and the compliance and assurance toolkit are now available on the department's website. The practice handbook has been updated with new information including patient enrolment processes, payment systems and shared care planning. A new shared care planning factsheet; and new QandAs on the Health Care Homes evaluation are also available. Visit more information for health professionals to access these resources. Bookmark these pages for easy accessUpdated information on shared care planningAll participating practices and ACCHS need to be using shared care planning software that meets Health Care Homes' minimum requirements by 30 November 2018. To assist practices to select a system that meets their needs and those of their patients, the Medical Software Industry Association (MSIA) has worked with software developers to create a shared care planning matrix. The matrix outlines how products meet each of the minimum requirements and includes additional information that will be of interest to practices such as compatibility with existing software, access to training and support and additional capabilities. Earn CPD points with Health Care Homes trainingAGPAL has been working with the accreditation bodies to enable Health Care Homes' learners to be able to claim points from their accreditation bodies, including: • The Royal Australian College of General Practitioners (RACGP) • The Australian College of Rural and Remote Medicine (ACRRM) • The Australian Primary Health Care Nurses Association (APNA) • The Australian Association of Practice Managers (AAPM) Modules 1-10 have now been endorsed by the above organisations. Details on continuing professional development is currently being added to the introduction section of each module, so practices are aware of the CPD points available on completion of that module. A summary of the CPD information for all modules will also be made available under the resources tab of Module 1. To claim CPD points, users can print the relevant certificate on completion of the module. Wishing you all a safe and restful Christmas break. |