Trial practices modelling ‘to be opened up’

The Department of Health will open up the economic modelling of all general practices in the Health Care Home trials, including corporate participants. Assistant secretary Janet Quigley revealed the plan after being quizzed about the representative mix of the experiment to apply team-based, bundled-payment care systems for chronically ill patients.

Ms Quigley said the selection process had employed a “sampling frame” to ensure broad coverage so that the analysis could be “cut” in a number of ways.

“We wanted to make sure we can test it in various geographies, business models and locations, and business types,” she told delegates at the Rural Medicine Australia conference last week.
The trials, to run for two years and involve 200 practices, use three tiers of payments depending on the complexity of the patients enrolled.

Of the 176 practices signed up so far, 40 were in regional, rural and remote areas, classed as 4-7 under the Modified Monash Model, she said. Of those, 25% were corporates.

But in Queensland and Western Australia, the trials are confined to parts of the capital cities of Perth and Brisbane.

Queensland GP Dr John Hall questioned how the HCH scheme’s viability would be tested in the “hybrid” practices common in regional and rural Queensland, where GPs work in private practice and cover local hospitals.

“Even those models in Queensland at the moment are falling over,” he said, adding extra money would also be needed to pay for allied healthcare.

Dr Hall, a GP in Oakey in Queensland’s Darling Downs region, said he was disappointed that no HCH control sites were located in his PHN area.

“I don’t think they’ve hit the mark in terms of getting a representative group of practices in the trial. They didn’t ask us. There was no consultation. I think it was based on which PHNs were functional at the time.”

While no extra rural loadings were offered in the trials, potentially rural practices would be paid more under the HCH stratification tool used to classify patients, Ms Quigley said.

“The tool looks at both clinical and social issues. So, tier 3 is the top tier – and some of the social elements are isolation, rurality and indigeneity. That’s where we could see the patient get scaled up in the complexity tier.”

Tier 3 will pay $1795 per annum per patient. The lowest level, tier 1, will pay $591, and tier 2 will be worth $1267.

NSW GP Dr Jenny May said it would be hard to assess how the HCH scheme could be applied to general practice without full disclosure of the different elements of the modelling.

“There is absolutely no doubt that developing allied healthcare teams working with general practice is what we want. I would love to have a pharmacist working in my practice doing medication management and supporting my older patients,” the Tamworth GP said.

“But how does that work? Do we have the financial levers within the holistic model that is being proposed that will provide the answers to my question?”

Ms Quigley said the department would release the modelling.

“We have always worked from the premise that the evaluation will be made public. It’s got to feed into cabinet decisions and government discussions,” she said.

She expressed confidence that the trials had captured the variety of GP business models, adding that about 20 Aboriginal Medical Services were taking part.

“We were really happy with the spread,” she said. “We have also tried to make sure we get practices that are both ready and working in this space, versus those that aren’t.”

The validation of the payment tiers in different settings was one of the key things the department would analyse, she said.

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