Sunday, May 22, 2016

If All You Have Is A Hammer, Everything Looks Like A Nail - The Story Of myHR Use In Medical Home Trials.

This release appeared a while ago:

A Healthier Medicare for chronically-ill patients

The Australian Government will revolutionise the way we care for Australians with chronic diseases and complex conditions – aiming to keep them out-of-hospital and living happier and healthier lives at home.
Page last updated: 31 March 2016

Joint Media Release

The Hon. Malcolm Turnbull MP
Prime Minister

The Hon Sussan Ley MP
Minister for Health
Minister for Aged Care
Minister for Sport

31 March 2016
The Turnbull Government will revolutionise the way we care for Australians with chronic diseases and complex conditions – aiming to keep them out-of-hospital and living happier and healthier lives at home.
Our Healthier Medicare package is one of the biggest health system reforms since the introduction of Medicare 30 years ago.
Patients with multiple chronic conditions will get a health care package tailored to their needs and that care will then be co-ordinated to help them easily navigate the complex system.
As many as one-in-five Australians now live with two or more chronic health conditions.
The most prominent are diabetes, heart disease, cancer, mental health, eye disease, respiratory conditions and arthritis – requiring a range of health services from their GP through to specialists, nurses, pharmacists, physiotherapists, psychologists, dieticians and weight-loss programs.
This figure is even higher for Indigenous Australians, with a third reporting three or more long-term conditions.
Australians who are high users of the health system see as many as five different GPs per year – triple those with lower-use of the system. Seeing multiple GPs increases a patient’s risk of poor healthcare co-ordination and their likelihood of falling through the cracks and ending up in hospital.
Half of all potentially avoidable hospital admissions in 2013/14 were attributed to chronic conditions. That is one every two to three minutes.
The primary care package will be trialled through creating ‘Health Care Homes’ that will be responsible for the ongoing co-ordination, management and support of a patient’s care.
About 65,000 Australians will participate in initial two-year trials in up to 200 medical practices from 1 July 2017.
The Council of Australian Governments has discussed the benefits of primary care and the Prime Minister on Friday will invite state and territory leaders to partner with the Commonwealth on these reforms. We want to reduce the barriers patients face across fragmented health services, with the aim of keeping them well at home and out of hospital.
Simplifying a chronically-ill patient’s care by allowing them to nominate one GP practice as their ‘home base’, in conjunction with other Turnbull Government reforms such as our new digital MyHealth Record, will empower patients to take better control of their own care.
It will also reduce potentially life-threatening and costly inefficiencies in our health system, including hospitals.
We will provide quality patient outcomes in Commonwealth-funded primary health care services for the chronically ill to keep more Australians healthier, happier and out-of-hospital.
The announcement is a core part of Government’s response to our Primary Health Care Advisory Group review, released today and chaired by former Australian Medical Association President Steve Hambleton.
An extra $21 million will be committed to support the rollout of trials. The remaining balance of the package is expected to be cost neutral, in line with PHCAG recommendations, with further evaluation to continue ahead of a national rollout.
If we don’t act, Commonwealth health spending as a proportion of GDP will increase by over 50 per cent within 50 years because of higher rates of chronic disease.
Key Details
The Turnbull Government’s primary health care reforms, as part of its Healthier Medicare package, will consist of:
    • Tailored patient care plans developed in partnership with patients and their families.
    • The establishment of ‘Health Care Homes’, which will co-ordinate all of the medical, allied health and out-of-hospital services required as part of a patient’s tailored care plan. Health Care Homes will be delivered by GP practices or Aboriginal Medical Services. Patients will be able to enrol with the Home of their choice.
    • Payments for Health Care Homes will be bundled together into regular quarterly payments. This will encourage providers to be flexible and innovative in how they communicate and deliver care, and will ensure that the patient’s health care needs are regularly monitored and reviewed. This signals a move away from the current fee-for-service model for these eligible patients, except where a routine health issue does not relate to their chronic illness.
    • Improved use of digital health measures to improve patient access and efficiency, including the new MyHealth Record, telehealth and teleweb services, remote health monitoring and medication management technologies etc.
    • A risk stratification tool to determine an individual patient’s eligibility for the new packages.
    • Stronger data collection, measurement and evaluation tools to allow a patient’s individual progress to be measured and their care plan to be better tailored to their needs.
    • The creation of a National Minimum Data Set of de-identified information to help measure and benchmark primary health care performance at a local, regional and national level to inform policy and help identify regionally-specific issues and areas for improvement.
    • Processes to empower patients and their families to be partners in their own care and take greater responsibility for the management of their conditions.
    • Greater co-ordination between Primary Health Care Networks (PHNs) and Local Hospital Networks (LHNs) in the planning and procurement of health services for their local communities.
    • Additional training to care coordinators and providers so they are aware of their responsibilities under the new model.
    • A Health Care Home implementation advisory group to oversee the design, implementation and evaluation of the trials ahead of the national rollout.
Here is the link:
There are a few things to be said about all this but the main point I think needs to be made is as the blog title says - if all you have in patient records is myHR then that is what you will use to conduct the trials - rather than actually analyse what is needed in the trials and deploying a proper system to meet those needs.
Without playing favourites there are at least two systems available and implemented in Australia that are much better able to meet the needs of care-coordination and the range of users that need access and share to such information.
Additionally it is important to note that the concept of a Medical or Healthcare Home has been around for years and has not proved to be all that successful.
Here is a review of major trials in the US which really did not turn out all that well.

Patient-centered medical home program results in little improvement in quality

Date: February 25, 2014
Source: The JAMA Network Journals
One of the first, largest, and longest-running multipayer trials of patient-centered medical home medical practices in the United States was associated with limited improvements in quality and was not associated with reductions in use of hospital, emergency department, or ambulatory care services or total costs of care over three years, according to a study. The patient-centered medical home is a team-based model of primary care practice intended to improve the quality, efficiency, and patient experience of care. Professional associations, payers, policy makers, and other stakeholders have advocated for the patient-centered medical home model.
See a lot more information here:
All we can do is hope that light will dawn and the trials will be enabled by the best possible technology to give the whole initiative at least some small chance of success. Dream on I guess.


johnd said...

No strictly related to the topic.

I'm interested in the phrase "Australians who are high users of the health system see as many as five different GPs per year". What does this mean? Are they really talking about different GPs (different people), or different multi-GP practices?
It seems to me that if I see two different GPs in the same practice, this is fundamentally different to seeing two GPs in different, unrelated practices.
I know this is not the point of this post, but you see these types of figures quoted constantly with no actual definition. They make good newsbytes, but provide no real information at all.

Anonymous said...

"Greater co-ordination between Primary Health Care Networks (PHNs) and Local Hospital Networks (LHNs) in the planning and procurement of health services for their local communities."
Given the way PHNs and their predecessors squander (jobs for mates) and hoard money (self preservation), I wonder how much will be left for 'procurement' (for their favorites) after they conduct their 'planning'?