As you’ve no doubt heard, the Federal Government this week released the guidelines for organisations seeking to become Medicare Locals. It also released this document that aims to explain primary health care reform for the general public.
It is remarkable that such critical documents pay no explicit attention to two fundamental elements of primary health care – achieving greater equity and addressing the social determinants of health. If the framework outlined in the Marmot Review, “Fair Society, Healthy Lives”, had been used to guide the preparation of these documents, they would have read very differently.
Apart from the tight timeline (a 5 April deadline for those MLs starting in July, and a 19 July deadline for those seeking to start in January or July 2012), applicants face the unusual challenge of applying for what might be a moving feast – the final ML boundaries are not yet settled. A review of the previously announced boundaries is to be undertaken in consultation with states and territories, and will report in April.
For those who haven’t yet seen the application guidelines, I’ve extracted some relevant sections below (if you want me to email you the full document, please post a note below). I hope to post some comment and analysis from Croakey contributors in coming days.
Extracts from guidelines to ML applicants…
Medicare Locals are to be established as independent companies limited by guarantee, managed by skills based boards. Applications proposing alternative arrangements will not be considered.
Medicare Locals will be responsible for a range of functions aimed at:
making it easier for patients to navigate the local health care system; providing more integrated care;
ensuring more responsive local GP and primary health care services that meet the needs and priorities of patients and communities; and
making primary health care work as an effective system as part of the overall health system.
Objective 1: Improving the patient journey through developing integrated and coordinated services
To achieve this objective Medicare Locals are expected to:
i work to make the health system function seamlessly for patients, though links with Local Hospital Networks, so that primary health care is a part of an integrated health system;
ii establish processes to engage effectively with patients, clinicians, Local Hospital Networks, local Lead Clinician Groups, once established, and other stakeholders to identify and remedy service gaps and breakdowns in service integration and coordination;
iii work with patients and the local clinical community to develop, monitor and maintain high patient care standards and integrated and coordinated clinical pathways to improve access to services, including after-hours services and telehealth services, provided in the most appropriate setting, and connectedness between services in the local area; and
iv improve patient awareness of the availability of services by maintaining and ensuring access to relevant and current service directories.
Objective 2: Provide support to clinicians and service providers to improve patient care
To achieve this objective, Medicare Locals are expected to:
i proactively engage with practitioners across the spectrum of primary health care provision;
ii provide practice support to improve the uptake of best practice in primary health care;
iii integrate varied provider types and models of care to reflect optimal care coordination; and
iv assist primary health care providers to meet safety and quality standards of service delivery, including monitoring and providing feedback to providers on their performance.
Objective 3: Identification of the health needs of local areas and development of locally focused and responsive services
To achieve this objective, Medicare Locals are expected to have the appropriate expertise in data collection and analysis, strategies and referral pathways to:
i maintain a population health database including community health and wellbeing measures, provide input to population health profiles, and undertake population health needs assessment and planning;
ii actively participate in the performance and accountability framework of the Government’s health reforms;
iii undertake detailed analyses of primary health care service gaps and identify evidence-based strategies to improve health outcomes and the quality of service delivery in local area populations, including for disadvantaged or under-serviced population groups;
iv conduct joint service planning with Local Hospital Networks and other appropriate organisations; and
v facilitate a reduction in inappropriate or inefficient service utilisation and avoidable hospitalisations.
Objective 4: Facilitation of the implementation and successful performance of primary health care initiatives and programs
To achieve this objective, Medicare Locals are expected to:
i improve the focus on prevention and early intervention in primary health care;
ii improve service delivery, clinical efficiency and efficacy, and drive appropriate service utilisation;
iii coordinate the delivery of local area primary health care reform initiatives; and
iv ensure the seamless transition of programs and services from existing Divisions of General Practice operating within the local area, including transfer of funding, staffing and corporate knowledge.
Objective 5: Be efficient and accountable with strong governance and effective management
To achieve this objective, Medicare Locals are expected to have:
i appropriate company, board and senior management structures and processes – to manage risk, ensure compliance with all legal and fiduciary responsibilities, ensure financial viability and accountability, and to attract and retain essential skills across the extent of corporate and primary health care expertise;
ii capacity to drive more efficient utilisation of health and administrative resources – including through contract management, resource allocation and acquittal, budget management, and contributing to efficiency and equity across health sectors in the local area;
iii sufficient capacity and expertise to effectively and efficiently manage flexible funding to target services to their local community’s specific needs;
iv mechanisms to appropriately integrate information relating to clinical priorities and governance – including links with Local Hospital Networks and local Lead Clinician Groups once established;
v appropriate data collection, performance monitoring and reporting processes – including a commitment to participating within a nationally consistent performance framework and monitoring of definitive outcomes related to Medicare Locals’ core business requirements;
vi decision making processes that are responsive to local health care needs and accountable across the spectrum of the local community and primary health care providers; and
vii capacity to remain flexible and responsive to evolving circumstances.
A total of $477 million over four years will be provided to establish a national network of Medicare Locals across Australia.
Once all Medicare Locals are established, the total annual core funding for the Medicare Local network will be approximately $171 million.
Medicare Locals will also be provided with funding to support their establishment.
The distribution of this funding between Medicare Locals will be based on a funding formula that takes into account the characteristics of each Medicare Local such as rurality, socio-economic, health and Aboriginal and Torres Strait Islander status of the community.
Commonwealth funding will be provided through a funding agreement which will detail the terms and conditions of the funding. Details of these funding agreements, including transition arrangements, will be negotiated between the Commonwealth and preferred applicants following the finalisation of the selection process. Parties involved in these negotiations should ensure they are familiar with, and seek legal advice on, the terms and conditions of the funding agreement.
As Medicare Locals will substantially build on the work of Divisions of General Practice, core funding to Divisions of General Practice under the Divisions of General Practice Program will progressively transfer to the Medicare Locals program. All core funding under the Divisions of General Practice Program will cease on 30 June 2012.
All existing program funding to Divisions of General Practice will be directed through the Medicare Local and over time this will be absorbed into a single funding agreement
As part of the Commonwealth’s primary health care reforms, all Medicare Locals will also be provided funding to plan, coordinate and support local after hours GP services.
Over time, Medicare Locals will be given the capacity to use Commonwealth program funding flexibly.
Medicare Locals are to be established as independent companies limited by guarantee, managed by skills based boards, and as such will be subject to the Corporations Act 2001. Applications proposing alternative arrangements will not be considered.
In general it is expected that:
board and governance appointment processes should be robust and transparent and incorporate the required range of skills. In addition the membership should be involved in appointment processes;
governance arrangements should promote strong linkages between Medicare Locals and local health care professionals, Local Hospital Networks, and the community to ensure services work with each other;
Medicare Locals and Local Hospital Networks will be expected to have some common membership of governance structures where possible;
governance arrangements should adequately reflect the Medicare Local catchment’s community and health care service providers within the area, as well as business and management expertise and have strong clinical leadership; and
boards are expected to comprise between about seven and nine people and members should have expertise in areas including knowledge of local healthcare
It is preferred that Medicare Locals will be expected to operate under an organisational membership model – with members such as local health services and community groups – rather than the individual membership basis used for current Divisions of General Practice.
The Government expects that membership should cover the full range of primary care providers in an area and the broader local community.
Medicare Locals will operate within an environment in which they are accountable to both the Commonwealth and their local community. This ITA process allows applicants the opportunity to develop governance arrangements that are appropriate to their Medicare Local area and meet the needs of their community whilst meeting good governance principles. This means that Medicare Locals across the country will, to a degree, have different approaches to governance that are tailored to the needs of their community.
Who will form Medicare Locals?
Medicare Locals may be formed by a single organisation or a group of organisations, a partnership, joint venture or consortium.
It is envisaged that Medicare Locals will reflect the range of organisational expertise needed to deliver an expanded suite of programs and services within defined Medicare Local boundaries and population catchments. Such combinations are expected to include Divisions of General Practice and, depending on the local community and range of other primary health care organisations and services, an Aboriginal Medical Service, a Primary Care Partnership, allied health service, non-government service provider and other appropriate organisations.
Demonstrated expertise and capacity to address the five Strategic Objectives for Medicare Locals specified above, for the selected catchment area including outlining:
i. Activities currently undertaken and previous achievements which relate to each of the five strategic objectives;
ii. How these activities can be extended and expanded to meet the needs of a modern primary health care system;
iii. Demonstrated knowledge of the population base, health service architecture and infrastructure, utilisation and other demographic characteristics and health priorities in the proposed catchment area (this should indicate the evidence from which this knowledge is drawn);
iv. A strategy for development of a population and health service plan to address need; v. Infrastructure already in place;
vi. Capacity to collect and manage data as appropriate;
vii. Strategies for ensuring appropriate accountability and transparency to the community; and
viii. Indicative personnel and other resources to be allocated to deliver these activities.
Proposed governance and operational arrangements, including:
i. Details of the proposed legal/corporate and organisational structures; ii. Experience and skills expertise of the proposed Executive;
iii. A structure that recognises the diversity of clinicians, services and health care recipients within the modern primary health care sector;
iv. Structures that encourage and maintain local engagement and responsiveness; v. A transition plan, including estimates of costs associated with transition activities;
vi. Strategy for ensuring appropriate clinical governance;
vii. Strategy, skills and expertise to manage flexible funding to target services to the local community’s specific needs;
viii. Strategy for establishing effective linkages with other sectors and organisations, including Local Hospital Networks; and
ix. Strategy for ensuring community engagement and accountability.
The assessment panel will have regard for the desired governance attributes, including broad community and health professional representation, as well as business management expertise; and strong clinical leadership.
The financial viability of the Medicare Local including:
i. Demonstrated record in efficient and effective use of funds of each organisation covered by the proposal;
ii. The experience and expertise of the organisation’s proposed executive team to manage substantial public funds appropriately; and
iii. Current contractual arrangements.
Demonstrated evidence of ability to engage with and form productive relationships with key stakeholders, providing supporting evidence of any current partnerships and operational arrangements, and strategies to improve engagement with:
i. Community Organisations; ii. Aboriginal and Torres Strait Islander Health Organisations;
iii. Workforce Organisations; iv. General practice;
v. The broader primary health care sector; and vi. Research Organisations.
Strategies and ability to respond to local needs and emerging priorities, including Commonwealth priorities in Aboriginal and Torres Strait Islander health, eHealth and telehealth, mental primary health care, aged care, population health and after hours primary health care.
Evidence of ability to build upon a sustained track record of high performance as a Division/s of General Practice or primary health care related organisation, including:
i. Driving improved outcomes and system change in general practice and primary health care through effective practice support;
ii. Improving eHealth and information management infrastructure, including the use of data to improve preventive health and chronic disease management in clinical practice, to measure the effectiveness of health program delivery, and to inform population–based services planning and evaluation;
iii. Effective governance and corporate management;
iv. Demonstrating effective collaborative relationships with other agencies and health service providers to achieved improved referral pathways, health service provision and/ or outcomes, including a demonstrated culture of inclusion across the spectrum of primary health care service provision and local community engagement;
v. Demonstrating compliance with contractual obligations;
vi. Delivering sustained achievement and improvement against national performance indicators for Divisions of General Practice (where relevant) and associated programs; and
vii. Actively sharing expertise and resources with others to promote quality improvement and knowledge transfer across the primary health care sector.
The selection panel will develop a relative merit list from the applications assessed, based on the selection criteria above, and provide recommendations of preferred applicants to the Minister for Health and Ageing.
viii. Marketing and branding
All Medicare Locals will be required to give due recognition to the Australian Government’s health reform agenda, as well as investment in the Medicare Locals program.
As such, Medicare Locals will be subject to common communications, marketing and branding protocols, which will be reflected in future funding agreements.
The Department will issue further advice and guidance on these matters in due course to successful Medicare Locals.