Doubts remain over funding for Health Care Homes trial

The original model of the medical home devised by the RACGP, the Consumers Health Forum of Australia, the Menzies Centre for Health Policy and the George Institute for Global Health (as outlined in Patient-centred healthcare homes in Australia: Towards successful implementation) envisioned a patient-focused healthcare practice that provided streamlined multidisciplinary care for patients with chronic disease.
 
However, some believe the Health Care Homes model being put forward for a large-scale trial by the Department of Health (DoH) has become something quite different.
 
‘The current trial is not of a healthcare home, rather it’s a trial of a capitated funding model for chronic disease, using a risk allocation software that has never been tested,’ Dr Evan Ackermann, GP and Chair of the RACGP Expert Committee – Quality Care, told newsGP.
 
‘It does nothing to solve service problems of identifying those at greatest need for health services and ensuring evidence-based systems of care are supported.’
 
The RACGP is critical of the DoH trial, withdrawing its earlier support and arguing that inadequate Government funding would ensure a poor result.
 
‘Introducing capitation, not only on funding for treatment of chronic medical conditions, but also on visits for unrelated acute medical presentations that do need attention, is nonsensical and sets up the Health Care Homes trial to fail,’ RACGP President Dr Bastian Seidel said.
 
Internal research conducted by the DoH has suggested patients are also sceptical of Health Care Homes, and the sites selected for the trial may have trouble recruiting the full number of participants required. In response, the DoH said it was changing its approach to communications, with an onus on the GPs at participating practices to explain the model to patients.
 
‘GPs can explain the benefits [of Health Care Homes] for the individual patient and their carers and family in much more detail than a general focus group process allows,’ a DoH spokesperson said.
 
But Dr Ackermann believes the Health Care Homes model needs more fundamental changes for success.
 
‘We need to return to the principles that underlie the RACGP funding model,’ he said. ‘If we want a highly performing health system, we must determine the roles general practices need to perform well, and then fund them appropriately.
 
‘This will require advanced management of general practice populations, not just individuals, which will need patient enrolment, services planning and health outcomes management skills.’

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