To meet the requirements of the Health Care Homes initiative, general practices will need to adapt to a new payment method and team-based care approach.
The Health Care Homes (HCH) programme is a new Commonwealth initiative which focuses on patients with chronic and complex conditions. Through more effective use of Medicare, it aims to transform general practices and Aboriginal Community Controlled Health Services (ACCHS) in ten Primary Health Networks (PHN) into a home base that will coordinate comprehensive care for patients1. The HCH bundled payment approach is hoped to encourage practice level innovation in service delivery, with the driving vision being the Quadruple Aim of Health care: that is, to improve the patient experience; to improve population health; to improve cost efficiency; and to improve the experience of the providers2. The program will also encourage a move towards a team based approach to care, as well as enrolling patients with a practice and a nominated lead GP.
The practice manager has an important role as a change agent and leader in any practice. In meeting the requirements of the HCH initiative, general practices, GPs and staff need to change and adapt to the new payment approach, and develop a new way of working. To help practice managers to do so, we have developed a number of tips that will help you reduce medico-legal risk:
it is important to be mindful that change is sometimes difficult, and that all staff and practice team members need to understand and accept the purpose, direction, and reasons for the change. The practice manager is in a key position to work closely with practice owners (or senior managers) on educating and motivating staff to gain a better understanding of the HCH model.
one of the key changes required in HCH is to embark on a journey of quality improvement, using practice level data on enrolled HCH patients to drive better service delivery. Whilst this may be already happening in a lot of general practices, helping staff understand the reason for data collection as well as building a “data culture” is an important role for practice managers. This will avoid disputes that arise from concerns around the internal use of data, and will help allay fears about data collection.
one of the fundamental “building blocks”3 that underpins the HCH initiative is team based care. All staff, including GPs, nurses, receptionist, medical practice assistants, and allied health professionals, are encouraged to work to the best of their ability and scope of knowledge and training. Work that is traditionally done by the GP can be delegated (where safe and appropriate) to other staff. The bundled payment facilitates this by no longer requiring the patient to attend a face to face consultation with the GP in order to be paid. Practice managers need to develop well defined policies and procedures around scope of practice for staff, and make sure that staff are adequately trained for the work they are asked to do.
The HCH model requires a number of steps and requirements that must be followed to comply with the enrolment process and associated payment approach. Developing an understanding of the resources available4, as well as developing a clear implementation plan within the practice, will ensure compliance with the program requirements and reduce risks that may be associated with audits.
in working closely with practice owners, practice managers have an important role in facilitating the fairness, transparency and model of distribution of payments to contracted GPs. As staff duties evolve and change, reviewing contracts and awards where necessary will avoid any potential disputes.
the HCH model encourages thinking about non face to face care and the use of electronic communication with patients. When used safely and effectively, these methods of care can increase the reach from within the practice and improve efficiency, staff and patient experience. Having clear polices and protocols around the use of electronic communication and IT security will limit medico-legal risks such loss to follow up and privacy breaches. It is also important to remember that no matter the form of contact, all contact with the patient should be adequately documented in the medical records. This equally applies to the proposed electronic shared care plan (a requirement of the program), which also needs to be made accessible and link seamlessly and be captured into the existing medical record.
built into the HCH model is a proactive approach to management of HCH patients’ chronic disease and care coordination. Recalls and reminders will be an important enabler of this approach, and can help reduce risks. Practice managers have an important role in developing and building upon existing systems that ensure safety and care is taken to make sure patients do not “fall through the cracks”.
HCH aims to encourage innovative service models that are centred on the health care needs of the patient. Practice managers have an important role in working with providers and staff to develop a service delivery framework which guides and meets patient expectations. Doing this may avoid complaints from dissatisfied patients.
The HCH model encourages team based care and population health. This will require access to patient records by clinical and non-clinical staff within a practice. The practice manager has an important role in building on existing polices in order to avoid privacy breaches and meet legislative requirements5. This also applies to access to the My Health Record, another requirement of the HCH program.
It will assess the effectiveness of innovative models of care. The practice manager has an important role in building a culture of high quality care, and to motivate all staff (including GPs) to learn to continuously improve, and to improve by continuously learning.
By: Avant Media