Opportunities for improved patient outcomes and fee growth

Many of you would have heard that as a result of consultations with the Primary Health Care Advisory Group in August 2015, the Federal Government has legislated reform plans designed to increase quality of care. One of the key initiatives is the provision of comprehensive care plans to over 65,000 patients with chronic or complex conditions, who require ongoing care. The plan is to roll out to 200 practices nationwide who opt to become Health Care Homes. Financial incentives will be available in the form of regular bundled payments. The total allocated funding until 2019 amounts to $114.3 million in additional funding and redirected MBS funding.

The Health Care Homes opportunity is a new approach to care in the community however as with any new reform program, it is important to plan carefully how and when to get involved so that your practice is well equipped to participate. There are some upfront differences that will arise with the new approach, not least the need for tailored care plans which need to be managed and scalable, and the integration with various practitioners will bring a raft of challenges.

Below are some of the areas to consider for practices looking to be involved:

  • The patient relationship will change.
    The Advocacy Group is of the opinion that increasing emphasis will be on regular contact instead of appointment based management as the focus will be less on today’s problem and more on the plan. Less face to face visits will be required as follow up and tracking can take place remotely using new technologies. Similarly, patient visits to allied health practitioners will become a regular visit as part of the care plan.

  • Collaboration with specialists and allied health practitioners will need to improve
    The main aim of the initiative is to provide comprehensively managed care to patients with seamless transition from practitioners to allied health practitioners. Building integrated networks with the required specialists and allied health providers to assure quality at a reasonable cost will be of the highest priority and is not an insignificant hurdle.
  • Information technology will become ever more important
    Workflows will need to be tracked and actioned from multiple locations by multiple users. Information sharing between various practitioners will be of high importance and needs to be effortless in order to be successful. Automation of workflows is a key concept that will free up resources which can then be re-deployed where they add more value. Cloud based information sharing and data management will provide practices with an opportunity to minimise IT spend while at the same time enjoying application support and maintenance under a service model; the practice can focus on its core business without the need to maintain hardware and software. A seamless integration with billing and management analysis will ensure that changes in profitability can be identified early and profit can be maximised.
  • Communication needs to be open
    While traditional practice management will remain vital to running the practice efficiently, it is important to ensure that administration staff and nurses understand the deliverables and strategy behind the change in how the practice is run. Engaging them early and enabling them to contribute to the change will result in a smooth transition.
  • Staffing is critical to success
    As information technology and process flow management become increasingly important, having the right people with the right skills on your team is essential. Problem solvers and staff who embrace change to improve daily operations will be an asset to the practice and drive the change proactively, identifying risks and possibilities early. An understanding of new technologies, project management and also traditional practice management is required. It’s not the number of staff, but their quality and ability to leverage resources will be a key success factor.


  • Impact on associate doctors
    Feedback we have received from associate doctors is around the fear that over the long term the changes will benefit only practices and support staff and divert funding from associate doctors who will not be able to provide the desired client care due to a lack of resources. Careful consideration should be given to how rewards for associate doctors are aligned and the benefits of the new model will need to be tangible for them.

  • Fees per patient and profitability will be major key progress indicators.
    Funding comes with very little conditions and can be used as each practice deems fit to serve its patients the best way possible. This puts cost management and efficiency at the centre of the success of the new health care homes. Fees per patient will be a strong indicator regarding how much care each individual will require. Profit per patient will indicate the efficiency of the practice and ongoing improvement in operations over time.
  • Outcomes will be tracked over time and benchmarked.
    As only ten primary health networks have been nominated for the first stage it has already been announced that the results from these ten networks will shape the future of the program and the rollout into other areas. Regional averages of patient health improvement in areas such as diabetes, body mass index, strokes and other medical events will be used to compare the different approaches used by the different Health Care Homes. The better performers will be rewarded with additional funding while the lower performers might see funding withdrawn. This approach to KPI setting introduces a risk/reward mechanism to the management of individual health. It sets a new precedent for healthcare in Australia.
  • Not every Health Care Home will be successful.
    Due to the limited amount of conditions attached to funding, different approaches will be developed by different practices. As the public seeks to maximise the value of the spend on Health Care Homes, practices which score higher in benchmarking exercises can be expected to be granted additional funds for expansion while under performing practices will see funding reduced.

Overall, the aim is that successful practices will deliver improved services to patients. In order to do so, the practice will need to run efficiently which in turn will result in greater profitability for practice owners. As practices demonstrate this efficiency through better client outcomes, funding will increase which will again lead to further growth and profit potential.

At Prosperity Health we understand the challenges that Health Care Homes will be facing in the coming months. Our team is able to support practices with this new operating environment, provide teams with the right tools to analyse your success and help practices to plan and implement a strategy to achieve beneficial outcomes for all involved To find out more, please contact Prosperity Health on 1300 795 515 or mail@prosperityhealth.com.au.

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