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Health Care Homes – Struggles and Successes

Health Care Homes – Blog 2 of 4 part series

In our last blog we talked about the official Health Care Home trials as well as ‘readiness’ sites (with their many and varied names).  The Train IT Medical team work with many practices across Australia who are official trial sites as well as practices actively involved with trialling innovative changes. We thought it is time we share some of the stories of successes and struggles – straight from the field!

Take a quick tour of some Health Care Home & high performing sites with Katrina Otto

Struggles:

1. Technology

  1. Without doubt technology is the major, constantly cited challenge.  Official Health Care Home sites  are required to use multiple software programs: their own clinical software, Pen Clinical Audit Tool and HPOS to register patients both for the health care home and the formal trial evaluation (a process said to be “onerous”).  In addition practices need additional technology eg:–
  • a risk stratification tool (that analyses the clinical software and categories patients into groups that then determines the funding) and
  • a real time care planning tool that the patient also has access to.

    Neither of these new tools were completely ready at the start of the trials and care planning tools especially remain a commonly cited challenge by most practices. It is common to hear reports the tools are ‘super clunky’ and ‘hard to navigate’, all requiring investment in training and time.In addition, the Local Health District (LHD) staff  are supposed to view the patient’s My Health Record & shared care planning tool electronically but it is reported they are not yet able to receive secure electronic communication from practices. We hear from practices “the LHD report they have not had any training so they do not know that they are supposed to view let alone how”. When HCH practices have requested the LHD to view My Health Record for referred patients they are therefore unable to do this. One HCH site was frustrated when they then received a request to send paper information to the LHD.

    Similarly, use of My Health Record for information sharing for Health Care Homes patients is an expectation for participating practices. At the start of the trials most patients would not have had a My Health Record and certainly all Specialists/Outpatients/allied health professionals across the country are still not yet connected and accessing My Health Record regularly.

2. Data

A preliminary requirement for participation in the Health Care Home trial is a minimum dataset that is used to determine complexity of needs ie which ‘tier’ is appropriate for each patient.  In addition, the ‘data’ needs to be correctly coded and up-to-date. We are still receiving requests to teach ‘how to code a diagnosis’ in the clinical information systems as well as how to ‘identify patients at risk’ indicating there was possibly  an over-estimation of how much data is currently collected by practices and the currency/quality of that data. These data and technology challenges have slowed trial progress significantly.

3. Business Model & Change Management 

Introducing any change initiative in business is difficult let alone the enormity of this change which completely alters the fundamental way practices work (and only for some of their patients and doctors). Add to that the need for improved collaboration, electronic communication and new technology tools that depend on quality data and this presents an enormous challenge. One Western Australian GP in a HCH site said “it is slower for me now as I have to think about whether they are a Health Care Home patient and whether this particular presentation relates to the patients chronic condition”.  Another NSW HCH site said they spent their entire up-front bundled payment on “education & change management”.

Savvy business managers have said “we are certainly not financially worse off”  however expressed concern about evolving their entire business model without any guarantees of continuation. They also spoke to the challenges of changing their business model for a fraction of the practice. “Dilutes the ability for us to implement an effective change.”

4. Clinician & patient engagement – i) Getting GPs to agree to trial a completely new way of working (with regular speculation of trial discontinuation and insufficient funding) is a huge challenge and ii) doctors are the ones who engage the patients so without them there is no trial of anything new. Many Practice Managers report that in their practice they have one GP who is a keen ‘early adopter’ and they enthusiastically signed on for the trial only to experience resistance when inviting their colleagues to join them. It would also seem some of the initial trial sites were signed up by corporate management without engaging the doctors. It is reported many of these sites have since withdrawn from the trials.

Successes:

Providing better coordinated and flexible care are goals of the Health Care Home trials.
Practices report that the model is less prescriptive than the current fee for service model and allows for greater flexibility in terms of determining the right mix of care provision for individual patient needs.
Increase in flexible care has resulted in patients needing to attend the practice less while receiving more personalised care from multiple providers in the health care home team. “Feels like I have a personal carer” – HCH patient to Practice Nurse.

Doctors are pleased they can now be paid for all activities that are usually not billable under the fee for service model. “So far doctors are quite happy with how it’s going”.

As some HCH sites are still registering patients I would have thought it would be too early for health outcome success stories however by talking with HCH practice teams & their PHN support facilitators we are hearing many encouraging health and practice improvements. We will share those real patient benefit stories in the next blog.

Benefits identified so far fall into the following categories:

  1. Health improvementsRead ‘Norma’s story’ here.
  2. Team care  – “Even the receptionist is caring for me and looking after my health now” – HCH patient
  3. Financial – “Not created any financial disadvantage” – Practice Manager

We will detail ‘Success stories’ next week in Part 3 of this blog series. We will then report on non-trial sites introducing innovative approaches to patient care. If you hear of any interesting practice models let us know. The more we share the more we benefit as a healthcare community.

 

 

 

Global Learning: In October Katrina will share stories of innovative patient-centred care live from her US ‘person-centred care study tour’.
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Learn more about Health Care Homes

 

Disclaimer: Please note I am an independent trainer and Practice Management Consultant. While I am an approved trainer for the Dept of Health, Australian Digital Health Agency, Primary Health Networks, AHPRA, AAPM, APNA, AHPA, MedicalDirector, Best Practice Software, Avant Mutual Group, MDA National  etc and regularly present education sessions on behalf of organisations, the feedback and opinions expressed in these blogs are my own. Katrina Otto

 

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