Australian Doctor Australian Doctor 27th October 2017 | Page 30

Gut Feelings
Health Care Homes won’t solve
chronic disease care
T
Guest
Editorial
Professor
Stephen Leeder
30
HE establishment of medi-
cal homes based on vol-
untary general practice
registration has begun for-
mally, and quietly.
At the start of this month, the first
22 Health Care Homes pilot sites
began registering their patients with
chronic illness, with another 180
due to go live in two months’ time.
The Federal Government has
agreed to pay practices lump sums
of $591 a year for patients with
mainly self-managed illness, $1267
for those with moderate illness and
$1795 for patients with chronic and
complex needs, including palliative
care.
In return, these homes will pro-
vide continuing primary care for
these patients — delivered by a team
of health professionals.
The Health Care Homes reform
will finally test the effectiveness of
the medical homes model that has
been lauded for many years as key
to improving the care of those with
chronic and complex problems.
We must be clear from the start
that Health Care Homes is not going
to be the only solution to chronic
disease care — but it could be one of
the solutions.
Over the next five years, if medical
homes become part of the Australian
healthcare system, it will be impor-
tant not to overload them with too
many expectations.
Instead, we’ll need to assess what
they do — and don’t — do well.
| Australian Doctor | 27 October 2017
The reality is that although seri-
ous and continuing illness take up
to one-third of GPs’ time and fill the
majority of hospital beds, we have
been slow to adapt our way of man-
aging them.
These illnesses are usually defined
in the life of the patient by intermit-
tent acute episodes. It is these events
that can and should be better man-
aged in their early stages, by commu-
nity-based practitioners who know
the patient and can determine what
tice for patients with chronic illness.
The first two are now complete,
revealing there is serious unmet
healthcare need in the community,
and that the pursuit of integrated
care as a way to reduce costs, at least
in the Australian setting, may be in
vain.
Such trials may make for greater
practitioner and patient satisfac-
tion, but we found no measurable
decrease in hospital admissions. 1
What we did find was a need for
PATIENTS WITH CHRONIC DISEASES
ARE OFTEN IN DEEP AND COMPLEX TROUBLE.
THEIR NEEDS ARE MULTIPLE AND EXTEND
FROM MONEY TO LONELINESS.
is best — rather than an ambulance
automatically being called.
Yet, the infrastructure — practice
management, staff and support — to
effectively provide this kind of care
is expensive. Whether the proposed
Health Care Homes fee structure
will be adequate remains to be seen.
From experience, however, I can
say that such trials often fail to dem-
onstrate the effectiveness of major
changes in care delivery.
Over the past few years, I have
been involved in three experimen-
tal programs in western Sydney
designed to better integrate care
between hospital and general prac-
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increased investment in supportive
community-based services. 2
Part of the explanation for this is
that our understanding of the life of
a patient with serious and complex
illness is often incomplete.
Another study we undertook used
in-depth patient interviews to deter-
mine their perceptions o