Better Outcomes for people with Chronic and Complex Health Conditions



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Better Outcomes for people with Chronic and Complex Health Conditions

Report to Government on the Findings of the Primary Health Care Advisory Group



December 2015


Report of the Primary health care advisory group 2015

Primary Health Care Advisory Group Final Report Better Outcomes for People with Chronic and Complex Health Conditions

ISBN: 978-1-76007-252-0

Online ISBN: 978-1-76007-253-7

Publications approval number: 11412

Copyright

© 2016 Commonwealth of Australia as represented by the Department of Health

This work is copyright. You may copy, print, download, display and reproduce the whole or part of this work in unaltered form for your own personal use or, if you are part of an organisation, for internal use within your organisation, but only if you or your organisation:



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Apart from rights as permitted by the Copyright Act 1968 (Cth) or allowed by this copyright notice, all other rights are reserved, including (but not limited to) all commercial rights.

Requests and inquiries concerning reproduction and other rights to use are to be sent to the Communication Branch, Department of Health, GPO Box 9848, Canberra ACT 2601, or via e-mail to copyright@health.gov.au.


Table of Contents


Executive summary 6

A new model of primary health care for patients with chronic and complex conditions 7

Implementation considerations 10

Summary of recommendations 11

Appropriate and effective care 11

System integration and improvement 11

Payment mechanisms to support a better primary health care system 13

Measuring the achievement of outcomes 14

Introduction 15

The case for reform 15

Governance of the primary health care system is complex 16

Building on past primary Health care reforms 16

Effective and appropriate care for people with chronic and complex conditions 18

Strategic Directions: 18

Key Recommendation 1: Better targeting OF Services for patients with chronic and complex conditions in accordance with need 20

Key Recommendation 2: Establish Health Care Homes 23

Key Recommendation 3: Activate patients to be engaged in their care 27

Key Recommendation 4: Establish effective mechanisms to support flexible team based care 29

System Integration and improvement 32

Strategic Directions: 32

Key Recommendation 5: Enhance regional planning 33

Key Recommendation 6: Maximise the effectiveness of private health insurance investment in the management of chronic conditions 36

Key Recommendation 7: Coordinate care across The Health system to improve patient experience 39

Key Recommendation 8: Support cultural change across the health system 40

Payment mechanisms to support a better primary health care system 41

Strategic Directions: 41

Key recommendation 9: Restructure the payment system to support the new Approach 41

Key Recommendation 10: Pursue opportunities for joint and pooled funding 48

Key Recommendation 11: Patients contribute to their health care costs to the extent that they are able 50

Measuring the achievement of outcomes 53

Strategic Directions: 53

Key Recommendation 12: Support a Quality and Continually Improving Primary Health Care Systems 53

Key Recommendation 13 – Establish a National Minimum Data Set for patients with chronic and complex conditions 55

Key Recommendation 14: Establish new Performance Reporting Arrangements 59

Key Recommendation 15: Integrate Evaluation Throughout Implementation of Reforms 59

Implementation considerations 60

Staged rollout 60

Appendices 62

Accronyms 62

Primary Health Care Advisory Group Terms of Reference 62

Process of the review 67

Consultation and collaboration 67

Patient experiences provided by the consumer health forum 72

Bibliography 83






Executive summary 6

A new model of primary health care for patients with chronic and complex conditions 7

Implementation considerations 10

Summary of recommendations 11

Appropriate and effective care 11

System integration and improvement 11

Payment mechanisms to support a better primary health care system 13

Measuring the achievement of outcomes 14

Introduction 15

The case for reform 15

Governance of the primary health care system is complex 16

Building on past primary Health care reforms 16

Effective and appropriate care for people with chronic and complex conditions 18

Strategic Directions: 18

Key Recommendation 1: Better targeting OF Services for patients with chronic and complex conditions in accordance with need 20

Key Recommendation 2: Establish Health Care Homes 23

Key Recommendation 3: Activate patients to be engaged in their care 27

Key Recommendation 4: Establish effective mechanisms to support flexible team based care 29

System Integration and improvement 32

Strategic Directions: 32

Key Recommendation 5: Enhance regional planning 33

Key Recommendation 6: Maximise the effectiveness of private health insurance investment in the management of chronic conditions 36

Key Recommendation 7: Coordinate care across The Health system to improve patient experience 39

Key Recommendation 8: Support cultural change across the health system 40

Payment mechanisms to support a better primary health care system 41

Strategic Directions: 41

Key recommendation 9: Restructure the payment system to support the new Approach 41

Key Recommendation 10: Pursue opportunities for joint and pooled funding 48

Key Recommendation 11: Patients contribute to their health care costs to the extent that they are able 50

Measuring the achievement of outcomes 53

Strategic Directions: 53

Key Recommendation 12: Support a Quality and Continually Improving Primary Health Care Systems 53

Key Recommendation 13 – Establish a National Minimum Data Set for patients with chronic and complex conditions 55

Key Recommendation 14: Establish new Performance Reporting Arrangements 59

Key Recommendation 15: Integrate Evaluation Throughout Implementation of Reforms 59

Implementation considerations 60

Staged rollout 60

Appendices 62

Accronyms 62

Primary Health Care Advisory Group Terms of Reference 62

Process of the review 67

Consultation and collaboration 67

Patient experiences provided by the consumer health forum 72

Bibliography 83





The Hon Sussan Ley MP

Minister for Health

Minister for Aged Care

Minister for Sport

Parliament House

Canberra ACT 2600



photo image of dr steve hambleton, chair; primary health care advisory group


Dear Minister,

It is my pleasure to present this report of the Primary Health Care Advisory Group: “Better Outcomes for people with Chronic and Complex Health Conditions”.

Our current primary health care system works well for the majority of Australians. However, for the growing number of people with chronic and complex conditions, care can be fragmented and the system can be difficult to navigate.

Through consultations with patients, carers, doctors, allied health professionals and health system organisations we have identified a model of care supported by a new way of funding that can transform the way we provide primary health care for Australians with chronic and complex conditions.

Central to the reform is the establishment of Health Care Homes, which provide continuity of care, coordinated services and a team based approach according to the needs and wishes of the patient. This new approach is supported by new payment mechanisms to better target available resources to improve patient outcomes.

Our new approach offers an opportunity to improve and modernise primary health care and maximise the role of patients as partners in their care. It represents innovative, evidence-based best practice that harnesses the opportunity of digital health care. Importantly, it has strong support from consumers and health care professionals alike.

On behalf of the Advisory Group, I commend this report to you and thank you for the opportunity to contribute to building a healthier Medicare.

Yours sincerely

Dr Steve Hambleton

Chair


Primary Health Care Advisory Group




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