Service providers in the HCH trial will require systems and information infrastructure that can facilitate accurate data collection and analysis as well as secure messaging systems for practitioners’ sharing of patient information. Yet significant variation in data and patient management systems currently exists.viii Indeed, there is still widespread use of faxes and paper-based mail rather than electronic communications in parts of the sector. The systems and information infrastructure deployed will need to facilitate team-based planning and management of patient care, collection and sharing of pharmacy and diagnostic imaging information. Accurate records for payments, monitoring and reporting of financial and health outcomes will also be critical for the ongoing operation and evaluation of the trial.
My Health Record (MHR), the national electronic health record, in its current state has been characterised as providing ‘at least some information’—but it could play a larger role in the HCH trial.ix MHR may already provide some benefits to consumers, especially those with multiple chronic conditions, even if its role is limited to ‘memory aid.’ With greater integration between MHR, practice and other systems, perhaps the HCH trial presents an opportunity to develop a more fit-for-purpose system.
Optimising the workforce and support across the wider system
Ensuring that the appropriate resources and settings are in place to provide team-based care is another key challenge. Since the trial’s announcement in March 2016, stakeholders have voiced concerns about the adequacy of funding. The May 2016-17 budget allocated just $21 million funding, specifically for design principles, IT systems and training; the August PHN announcement flagged another $93 million, albeit reallocated from MBS funding to “support flexible and innovative clinical service delivery.”x The sum of those allocations combined implies an average of $570,000 in set-up funding per home, based on 200 homes participating; or around $1,750 per patient, assuming the total number of 65,000 eligible patients enrol. There is no information to hand to make direct comparisons against recent programmes. Yet just crudely assuming the service delivery cost component in the HCH trial roughly equates to the patient cost component in the DCP trial, the implied funding for the HCH on a per patient basis would cover only around 65% of patient costs.[xi] Hence concerns remain around the adequacy of funding.
Support should after all extend beyond the ‘homes’ to other key participants in the wider HCH ecosystem such as Primary Health Networks (PHNs) and allied health practitioners. PHNs are expected to play key roles. Some of the 10 PHNs in which the HCH trial will proceed may be better placed to coordinate services; others may have greater challenges in terms of resourcing, capabilities and geography. Partnerships between PHNs, practitioners and service providers could be organised to facilitate shared services arrangements to support the trial.
Though allied health practitioners are expected to play a role in delivering team-based integrated care, they face existing constraints within the MBS funding for chronic disease management (CDM): for example, caps on the number of visits to allied health practitioners. Hence, removing such constraints may be another critical requirement for the success of the HCH trial.
Practitioners are expected to commit time to planning and managing integrated care delivery. Nurse practitioners and care coordinators may be well placed to take some of the burden off practitioners. Still there may also be some limitations to making optimum use of nurse practitioners. These could arise, for example, if the HCH trial is also going to involve Private Health Insurers (PHI) funding chronic care, as the Department of Health had earlier signalled. Additional reforms could be required to optimise use of the workforce in such cases.
Overcoming barriers to implementation
Local and international experience suggests that integrated primary care through a home-type approach can deliver improved health outcomes. However the right systems and policy settings must be in place. In the face of significant complexities and an ambitious timeline for the HCH trial, a focus on overcoming typical barriers to implementation is crucial. A successful trial could lay the foundation for a full-scale transformation of how our health sector addresses the mounting health and financial burdens linked to chronic and complex conditions.