Better outcomes for people with chronic disease – Submission by ACMH

Posted by on Sep 14, 2015 in Articles, Submissions | 0 comments

acmh_submission_coverThe Australian Government has commissioned ‘The Primary Health Care Advisory Group’ which will ‘investigate options into the reform of primary health care to support patients with complex and chronic illness, and the treatment of mental health conditions.’

The Advisory Group has released a discussion paper ‘Better Outcomes for People with Chronic and Complex Health Conditions through primary health care‘.

The Australian Centre for the Medical Home has made this submission to the group.

The submission argues that General Practice is well positioned to deliver the high value care that is required to address the challenge of the increasing incidence of chronic disease.

We need new funding streams that reimburse high quality, team based, data-driven care. This redesigned funding can bring alignment between the financial incentives, the professional incentives of GPs, and the needs of our patients and community. These funding changes will be disruptive in that many practices will have to change their business model to a more patient centred approach. They will have to focus on outcomes and value as well as activity. This will require significant clinical leadership, with patients and communities as partners.

The Australian Centre for the Medical Home argues that ‘ideal’ general practice funding is a blended system which incorporates the eight funding streams as listed below.

The submission suggests that practices that choose to be accountable for high-value high-quality care may register for the new funding streams that are additional to current Fee for Service, and that replace the current PIP program. To receive this supplementary funding, practices would need to demonstrate that they are participating in all aspects of the program and are accountable for improving their patients’ care and outcomes.

The Centre suggests that this program is referred to as The Australian Medical Home Program and those practices who choose to register are known as Australian Medical Homes.

Funding Streams for General Practice

  1. fee-for-service for acute, routine and chronic care consultations provided by GPs
  2. fee-for-service for specific activities preformed by practice nurses or other clinical members of the general practice team
  3. more flexible funding for people with complex and chronic conditions that enables systematic and proactive team based care.
  4. per capita funding for enrolled patients, enabling practices to be accountable for the health outcomes of a defined population and to support a focus on prevention and maintaining health
  5. funding to support participation in a data-driven Quality improvement program
  6. direct funding to support nominated quality activity, such as After Hours Care and Teaching.
  7. specific funding for nominated high care need patients for services such as home monitoring and more intense care coordination
  8. funding that supports general practice ‘in-reach’ into hospital care

The submission with supporting discussion is available here

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