When announcing the Health Care Homes pilot, the Prime Minister and (then) Health Minister, Sussan Ley, promised that it would deliver major gains for people with chronic conditions and the community generally.
These included: increased autonomy and control over health care options; more flexible and individualised care; improved access and efficiency of resource use; and reductions in preventable hospital admissions.
Almost a year on and progress towards these goals is unclear. One reason for this may be the lack of shared principles underpinning the development of the pilot, as outlined below by AHHA CEO Alison Verhoeven. She also identifies some key enablers that must be present in order for the pilot to achieve lasting change.
Alison Verhoeven writes:
In recent months, the Australian Government has been very quiet on progress towards rolling out the Health Care Homes trial.
If 1 July 2017 is to be the start date, as promised in the last federal budget, now is the time to be ensuring that all stakeholders, including patients, are moving forward together and contributing to much-needed debate on Health Care Homes and the type of health system we want in Australia in the future.
What is a Health Care Home?
A Health Care ‘Home’ is an existing general practice or Aboriginal Community Controlled Health Service that commits to a systematic approach to chronic disease management using a coordinated, evidence-based, multidisciplinary model of care.
Health Care Homes hold the potential for significant health system reform through truly coordinated and efficient care that is patient-centred, flexible and tailored to local needs and the capacity of the local workforce.
This is different to, and consequently a challenge to, existing models of care. Therefore, without shared principles for success, and the right enablers, there is significant potential for failure and the risk that this important reform will be shelved.
The Australian Healthcare and Hospitals Association (AHHA) has recently released a Deeble Institute Issues Brief on this topic—Health Care Homes: principles and enablers for their implementation in Australia.
Important basic principles
After considerable research, it is our view that if the Health Care Homes trial is to pave the way for enduring reform, the following principles need to be shared across government, the various Health Care Homes, the health system as a whole, and importantly, patients and their families and carers:
- a holistic view of health and wellbeing
- patient and family centred healthcare
- continuous and collaborative relationships
- a comprehensive team-based approach to healthcare
- shared decision-making, patient activation and engagement
- coordinated care across the care system
- accessible, affordable, equitable and appropriate care
- high-value, evidence-based, safe and quality care
- well-supported health care workforce and workplace environment
- sustainable funding to support principles, implementation and practices.
To achieve change organised around these principles, the following enablers must be part of the Health Care Home model:
- institutional and professional leadership from all levels of the healthcare system
- a mutually shared understanding of principles and objectives
- collaborative, sector-led planning and change management
- appropriate funding and incentives
- broad workforce engagement
- patient-centred, co-designed care
- outcomes-focused data and technology to support innovation
- models of coordinated care adapted to local circumstances
- operational and equity considerations, balanced with risk stratification.
In summary, these changes, which, importantly, are aimed aligning the business model with the care model in an enduring and sustainable way, will take time, up-front investment and strong leadership at all levels of the system.
Learning from experience
Although Health Care Homes are new to the Australian health system, there are many instances, both in Australia and worldwide, where health organisations have trialled or implemented models of coordinated care. Several examples are examined in the Deeble Issues Brief, including Australia’s own Aboriginal Community Controlled Health Services and the Veterans Care Program, which share many of the attributes required for successful implementation of Health Care Homes.
Alison Verhoeven is the CEO of the Australian Healthcare and Hospitals Association (AHHA).