Health Care Homes in 2017

Welcome to the first Health Care Homes e-newsletter for 2017.

2017 is shaping up to be an exciting year for Health Care Homes. Our ongoing work in partnership with experts across policy, data analysis, research and evaluation continues. We will also continue to meet regularly with working groups and key stakeholders.

ATM oversubscribed, selected practices notified in March

The application process for stage one of Health Care Homes was significantly oversubscribed. Applications are now being assessed, and up to 200 general practices and Aboriginal Community Controlled Health Services (ACCHS) will be selected for stage one.

Successful general practices and ACCHS will be notified in March 2017.

Building an evidence base for Health Care Homes

The department is working with Health Policy Analysis (HPA) on a rigorous evaluation of stage one of Health Care Homes.

HPA is leading a consortium with the University of NSW’s Centre for Big Data Research in Health and the University of Technology’s Centre for Health Economics Research and Evaluation.  

The HPA consortium will evaluate how the model works in different situations and settings. It will look at what works best for different patients, practice types and in different communities.

Qualitative and quantitative data on patient and clinician experiences, health outcomes, changes to how services are delivered and types of care provided will be collected. The new bundled payment system will also be evaluated.  

Evaluation findings will be used to refine the model prior to Government consideration of a national rollout.  

Patient enrolment

Enrolling a patient in a Health Care Home will be a new process for practices, doctors and for patients themselves.

The following provides an outline of how enrolment may be undertaken, from an initial consultation about the benefits of the model to a prospective patient, through to registering an eligible patient with the Department of Human Services’ Health Professionals Online Services (HPOS).

Successful practices will be trained on patient enrolment before enrolment begins in the second half of 2017. The admissions software and risk stratification tool referred to below will be among the key resources developed for stage one of Health Care Homes.

Step 1: Eligible patient identified

The practice identifies a potentially eligible patient via:

• the risk stratification software used by the practice.
• assessment of a patient during a consultation.
• or if a patient asks about enrolling in Health Care Homes.

Step 2: Patient is introduced to Health Care Homes

• The doctor, practice nurse or other staff member talks to the prospective patient about Health Care Homes.
• The practice gives the patient a brochure about Health Care Homes.

Step 3: Risk stratification

• The Health Care Home completes the second stage of the risk stratification tool for the patient, based on information provided by the patient during the consultation.
• The patient is confirmed as eligible and assessed as either Tier 1, 2 or 3.

Step 4: Patient consent

• The doctor gives the patient an enrolment and consent form; and a patient consent for data provision form.
• The practice gives the patient a resource pack with detailed information about Health Care Homes.

Step 5: Patient registration

• The practice registers the patient with HPOS.
• Bundled payments start from the date the patient is enrolled with the practice.

QandA on the quadruple aim

Dr Steve Hambleton is a practising GP, former president of the Australian Medical Association and the former chair of the Primary Health Care Advisory Group (PHCAG) which informed the design of the Health Care Homes model. In this extract from a recent QandA article, he discusses some of the clinical and practice-level strengths of Health Care Homes.

Q: In the Health Care Home model, how do you see the quadruple aim (enhancing patient experience, improving population health, reducing costs and improving the work life of health care providers) working?

A: All general practitioners want to work in a system that enables us to provide the highest standards of care to our patients. In the Health Care Home our patients don’t have to wait for the next available appointment to have a question answered. If their home monitoring and routine investigations show they are stable they can get access to repeat medications and their test results and speak to the practice nurse when needed.

With better data collection at the practice level, shared and de-identified at the primary health network (PHN), providers can prove their worth and contribute to population health. PHNs can seek and distribute resources according to need. 

Practices can operate more efficiently with shorter waiting times for patients who are acutely unwell. Over time, fewer and fewer patients with chronic disease present when they are unwell, as care plans are properly implemented. 

Stable chronic disease patients are supported by the team while the doctor deals with more complex and acute issues.

No longer is revenue dependant on rapid throughput or opportunistic care plans. Clinicians begin to feel more valued. Nurses, pharmacists and allied health providers, work to the top of their skill sets. Doctors have time to discuss options with the patient’s care team and can set goals for their care coordinators. Practices can demonstrate their worth as they compare their own results against their peers.

To see the whole of this QandA and the other resources, go to the Health Care Homes page.

Webinars

Two more webinars will be broadcast in the first half of 2017. Bookmark the webinar page to stay up-to-date with the upcoming schedule, which will be available soon.