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More funding needed for Health Care Homes trial

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GPs are still waiting for clarity on whether appropriate funding will be offered for services to patients under the Government’s $21 million Health Care Homes trial.

Under the model, also known as the Medical Home, patients suffering from complex and chronic health problems will be able to voluntarily enrol with a preferred general practice, with a particular GP to coordinate all care delivered.

The Government announced the model in March, with $21 million to allow about 65,000 Australians to participate in initial two-year trials in up to 200 medical practices from 1 July 2017.

The trial was one of the recommendations of the report of the 2015 Primary Health Care Advisory Group, headed by former AMA President Dr Steve Hambleton.

It was hailed as a step in the right direction for chronic disease management, with the Labor Opposition announcing plans for a similar trial.

However, the Labor proposal came with $100 million of funding, while under the Government model, the funding is not directed at services for patients, but rather on clinical need.

Professor Jane Gunn, the head of the General Practice Department at the University of Melbourne’s medical school, said the outcomes of similar trials, such as the 1994 coordinated care trials and the more recent diabetes care project, highlighted the difficulty in driving health delivery reform.

“The coordinated care trials showed some promise but were costly to implement and too costly to scale up,” Professor Gunn wrote on The Conversation website.

“They were difficult to replicate and few were sustained outside the trial environment.

“The impact of the diabetes care project was also disappointing. The diabetes care project included many of the elements of [the advisory group’s] report, such as bundled payments, yet only small gains were made in health outcomes and the cost-effectiveness of the model was not proven.

“The bundled payment used in the diabetes care project was viewed as inadequate.”

Making improvements in chronic disease management would require strong buy-in from all stakeholders, but it would be a challenge to get eligible practices and patients to sign on for the trial, she said.

“One of the biggest challenges will be to work out exactly how much the Government should pay a practice for providing a person with all their chronic disease care in a year,” Professor Gunn said.

“Working out how an individual GP will get their fair share of the chronic disease payment is likely to make for interesting negotiations and new ways of working for practice managers.

“Female GPs will be vulnerable to further pay inequities as they are less likely to be practice owners and more likely to work part-time.

“It is also not clear whether the recommended ‘bundled payment’ would include more radical models where the practice has to fund payment for pathology, imaging and medications from the ‘bundled payment’.”

AMA President, Dr Michael Gannon, said the AMA was keen to work with the Government to make the trial a success, but appropriate funding would be a critical test.

“The Medical Home is fundamental to the concept of the family doctor who can provide holistic and longitudinal care and, in leading the multidisciplinary care team, safeguard the appropriateness and continuity of care,” Dr Gannon said.

“BEACH data shows that GPs are managing more chronic disease. But they are under substantial financial pressure due to the Medicare freeze and a range of other funding cuts.

“GPs cannot afford to deliver enhanced care to patients with no extra support. If the funding model is not right, GPs will not engage with the trial and the model will struggle to succeed.”

With the right support, GPs can provide more preventive care services and greater management and coordination of care, keeping patients healthier and out of hospital, he said.

“Health played a major part in the Federal Election and the Government must now demonstrate that it has heard the people’s concern regarding the ongoing affordability of their health care,” Dr Gannon said.

“The Medical Home must be appropriately funded to succeed.”

Maria Hawthorne