What will Health Care Homes mean for nurses?

APNA's position statement on the Health Care Homes model demonstrates strong support for an initiative that aims to better assist and support people with chronic and complex health needs.

It will be a setting where patients can receive 'enhanced access to holistic coordinated care, and wraparound support for health needs', and will provide a team-based care approach where patients and carers are active members of the Health Care Home care team. APNA believes the nursing workforce will play an essential role in the success of the Health Care Homes model.


Shift focus away from fee-for-service and focus on preventative care using the team, say integrated care champions

As Australia embarks on the stage one trial of Health Care Homes, integrated care champions Dr Kirsten Meisinger and Dr Walid Jammal delivered a seminar to Department of Health staff, during a visit in late April.

“Patient–centred care has been part of GP training all along, and the really wonderful, really rich practice that many of the GPs do in Australia,” said Dr Meisinger.

Dr Meisinger is the incoming Medical Staff President for the Cambridge Health Alliance, a practice based outside Boston, Massachuttsetts, USA. She has done extensive international consulting on the patient-centred medical home model and is a consultant on the Health Care Homes training resources.

But as people are living longer, “many of the diseases that we’re trying to care for require a different model of care” to the episodic care model, she said.

Patient-centred and team-based care “is challenging because all physicians have been trained to work really [independently]”.

“We feel that responsibility very much on our shoulders. One of the beauties of team-based care is that [responsibility] is actually a bit of a burden and you do see alarming rates of physician burn out,” she said.     

“One of the wonderful parts that team-based care has brought to our practice is that sense that you’re not alone,” she said.

The burden of walking with the patient through their journey “is shared among the team, and that is a very empowering structure for the team, for the patient and for the GP”.

When the focus moves from the GP to the patient “the GP likes it more, gets home earlier, feels that they have done a better job and staff feel more important and more essential to the care of patients,” she said.

Dr Jammal told staff at the seminar that Health Care Homes is an opportunity "to shift the actual focus a little bit away from fee-for-service and really focus on preventative care... using the team".   

Dr Jammal is a Sydney-based GP and clinical lecturer at the University of Sydney and Western Sydney University.

“[The GP] cannot do everything. Yet I am trained to actually do everything. I’m trained to say... nothing is done without me being involved,” Dr Jammal said.

With integrated and team-based care, the GP is freed up to change tack and do the “really high-thinking clinical work”.

Dr Jammal is also a consultant on the Health Care Homes training resources.


Health Care Homes to start in two phases, 200 selected practices released

9 May 2017

Health Care Homes services will now have a deferred and phased start this year, under measures released in the 2017 Budget. Twenty practices will begin Health Care Home services on 1 October 2017, the other 180 practices will begin on 1 December 2017.

See the list of the 200 selected Health Care Homes practices.


Risk stratification tool to target the right patients

To help Health Care Homes target services for people with chronic and complex health conditions, they will all use the same risk stratification tool to identify eligible patients and place them in the appropriate tier.

Precedence Healthcare has won the tender to develop and implement the risk stratification tool and will work with CSIRO on both aspects of this project.

The risk stratification process will help providers identify patients who are eligible to enrol and to assess those patients’ risk factors, including the likelihood of unplanned hospitalisation.

Health care providers will assess the clinical and non-clinical factors that affect their patients’ health.

Patients will be asked for their consent to use their health and personal information for these purposes.

Further information on patient identification is available on the patient eligibility factsheet.


Panel discussion: Health Care Homes

APNA curated a panel discussion among primary health care leaders on Friday 5 May at the State of the Art National Conference.

A video of the panel will be made available to members shortly.

The panel was hosted by Dr Norman Swan and featured:

  • Karen Booth | APNA President
  • Tracey Johnson | CEO Inala Primary Care
  • Janet Quigley | First Assistant Secretary, Health Systems Policy, Department of Health
  • Dr Bastian Seidel | RACGP President
  • Leanne Wells | CEO Consumers Health Forum of Australia

Here's what they had to say:

The nursing workforce will play an essential role in Health Care Homes. Nurses are highly trained, trusted professionals able to make a significant contribution within Health Care Homes by pursuing truly team based, interdisciplinary care which puts patients at its heart. APNA supports the concept, and the role of patients and carers as active members of the care team. 
Karen Booth | President APNA

Patient Centred Medical Homes are well established in many other countries. They enable better utilisation of nurses and a range of other care providers for people whose health profiles warrant additional support. Effectively implemented healthcare homes should reduce stress in clinical teams, improve patient outcomes and deliver better value to taxpayers. 
Tracey Johnson | CEO Inala Primary Care

Health Care Homes is a key government initiative to reform the primary health care system.  The model aims to deliver more effective care for people with chronic and complex conditions and reduce demand on the acute sector, by encouraging practice level innovation and flexibility in how services are delivered.  The staged implementation enables all elements of the model to be tested and validated and participating practices will have a vital role in shaping the potential future rollout of this important reform.
Janet Quigley | First Assistant Secretary, Health Systems Policy | Department of Health

Health Care Homes have the potential to transform primary health care particularly for those with complex and chronic illness. The principle aims of Health Care Homes to encourage more team-based, coordinated and patient-focused care offer the potential of more satisfied health practitioners and patients. 
Leanne Wells | CEO Consumers Health Forum of Australia

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