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Health Care Homes – Success Stories so far

Health Care Homes – Blog 3 of 4 part series

It is really too early in the official Health Care Home trials to expect significant improvements in patient health outcomes. Many sites “took a while to get going” and some are still at the very beginning stage of registering patients. In last week’s blog I outlined technology and other challenges which have slowed progress.  This week however I want to share a few very early ‘success stories’.

Essentially, what we have found is greater flexibility is afforded to the practice under the Health Care Home model resulting in staff being able to innovate in terms of the nature, timing and setting in which health care is provided, depending on the needs of the individual patient.

Patient health improvements by providing ‘person-centred care’

“We are no longer limited to what we can do on the one day”

By removing the need for patients to always attend the practice in person and see the doctor every time (in order to bill Medicare) practices have the flexibility to care for patients in a manner that best suits the patient and their individual circumstances.

One Health Care Home trial site reports many improvements already with their small group of registered patients. These patients include one woman with severe COPD who now has her Webster pack proactively organised and delivered to her at home. Another patient is blind with complex needs who is benefiting from more proactive support via telephone calls from the Practice Nurse, health education and practical assistance with organising appointments and attendance.

Another improvement story was with a longer-term patient who had recently had his legs amputated. Prior to registering as a ‘Health Care Home’ patient this man avoided coming into the practice at all, often waiting until he was really sick to seek help. Now the Practice Nurse proactively helps co-ordinate his multiple health needs, transport and provides flexible care options to better suit his needs.

Improving access to care for patients and their carers is one of the goals of the Health Care Home model.  Read ‘Norma’s story here‘ which is an encouraging ‘success story’ from a carer’s perspective.

Another real ‘success story’ which I feel nicely highlights the difference of a health care home model is:

Before:
Patient with complex health needs and mobility challenges requiring fortnightly injections. Previous to HCH model this patient needed to make 3 trips:
-1-  to GP to get script
-2-  to pharmacy to get script filled
-3-  back to GP next day for injection.

Now
:
Nurse Co-ordinator communicates with the GP, proactively organises for the prescription to be sent to the pharmacy as soon as due and organises delivery.
The nursing and admin team personally remind the patient of her upcoming appointment and ensure that everything is ready for when the patient presents for their appointment. If the patient is unwell the Practice Nurse (or Nurse Practitioner or GP) can go to the patient’s home to assist with injection and care.
The patient reports:

“It feels like I have a personal carer. Even the receptionist is looking after me”.

Team-based care

Staffing changes and associated improved teamwork was often cited as a major change with the Health Care Home model that was providing multiple benefits. One HCH site in Perth now has 3 Nurse Practitioners, 1 GP, 1 RN, 1 EN and say they have significantly improved flexibility in how they can care for patients now they are not dependent on Medicare funding per face-to-face service. One Nurse Co-ordinator describes her new role as a “joy” and I heard many positive comments from nurses indicating greatly improved job satisfaction.

– One rural NSW practice now employs three Medical Practice Assistants (MPAs) and the Business Manager reports:

“The biggest difference is the patient’s ability to contact clinicians. MPAs carry a mobile phone that is a dedicated phone line for HCH patients. The MPA then triages and passes on to the GP or Practice Nurse as appropriate. As a practice we now have much better telephone triage because we have MPAs. This is saving significant nurse time while patients seem happier, stating they feel prioritised. Feedback from doctors is that patients are being properly triaged at reception now. There’s also a dedicated email address too so we are opening up many lines of communication outside of that face to face consultation model “.

– Practices in both trial sites and readiness sites report:

“there is now a focus on improving responsive patient care and a more proactive team approach.”

Business plans, practice values, visual management boards and ‘Quality Improvement’ team goals are displayed for visitors to see. Multidisciplinary staff communication improvements reported via initiatives such as ‘huddles’, Friday afternoon barbecues (‘Frabies’) and ‘cake days’ being just some examples of team building approaches. Both patients and staff cite improved ‘satisfaction’.

Financial improvements

“The money is enough. It is working well for us.” – GP

Savvy Practice Managers in the HCH trial report the changes introduced by moving from the fee for service model have not created any financial disadvantage (as seemed to be the expectation) compared to the previous fee for service model. In addition they state the changes have:

“lessened the workload of the doctors. The doctors are quite happy with the way things are progressing”.

Many sites reported doctors are pleased they can be paid for activities that are usually not billable under the fee for service model such as telephone advice, emails, writing scripts and referrals outside of consultations.

And one final story – because it’s particularly colourful:

A new patient to the practice presented with multiple, poorly managed chronic conditions. After spending some time with the Practice Nurse they “enthusiastically” registered to be a Health Care Home patient. The practice team implemented a proactive, co-ordinated plan to manage the patient’s complex needs. He was actively engaged in his own healthcare and receiving ongoing education and support from the healthcare team. His understanding of his conditions was improving and he was acting on medical advice with resulting significant health improvements. That was all until he returned to prison! Sad but true.

 

Summary

There really is no way anyone could adequately assess the Health Care Home ‘trial’ model at this stage.  Due to challenges with technology, change management and engagement, ‘Implementation Phase I’ is still at the very beginning of a long road with many lessons still to be learnt.

Personally I would have thought it would have been better to only include sites in the HCH trial who were already what I would call ‘high-performing sites’ ie using data and technology well, working to a solid business plan, co-ordinated team approach, safe systems and processes in place and undergoing continual quality improvements. Some of Australia’s ‘high-performing practices’ tell us they wanted to be in the trials but were not accepted.  I imagine this may have been intentional in order to allow studies of a range of practice types and models.

I would say one lesson I’ve learnt is that innovative models of care (and thinking) do need to be embedded into the practice from the beginning. Practices who were already progressive are flourishing with the broadened opportunities to provide care. Others are still working exactly the same way just with a different funding model.

In my opinion all practices in the trials are true Australian leaders. Most sites signed up out of good will and a genuine desire to improve care for patients. They are wearing the challenges without any certainty and in my opinion deserve our absolute respect and support.

 

More learning
In future posts in this ‘Health Care Home’ blog series I will report on alternative innovative models of care, and in October I will report live from my US ‘person-centred care’ study tour.  Learnings along the way will be shared so join the journey via: Facebook, Twitter or Linked In.

 

 

 

 

 

 

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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