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By Daryl Sadgrove, CEO.
The Australian Primary Healthcare Research institute (APHCRI) hosted a gathering of clinicians, policy makers and academics in Darwin on 29th June for a roundtable discussion on the governments’ recently announced Diabetes enrolment initiative. The government has committed a serious amount of money ($450million in fact), which is not due for release for two years (July 2012) to allow the new local hospital networks and Medicare-Local organisations to be established.
The key feature of this initiative is that it represents a move from fee-for-service to a capitation based model in primary health care, with performance incentives paid for achieving nominated outcomes.
Patients with diabetes will be eligible to voluntarily enrol with a participating general practice to manage their diabetes care. By enrolling they will forfeit access to some of the current EPC items, and they must agree to maintain a relationship with only one practice for their diabetes care. But in return they will be offered more comprehensive and flexible diabetes services that are intended to be more aligned with best practice care.
This model presents a range of challenges and opportunities for health managers that work in the primary healthcare setting. These include, but not limited to, managing contractual arrangements with funders and service providers, establishing and coordinating clinical governance models, managing teams who are often not co-located, and realigning the culture of general practices. The forum participants concurred that general practices are currently ill equipped to manage these challenges and that health management skills would be welcomed.
The benefits of moving to a capitation model are to get rid of the perverse focus on service volumes and tick-a-box health care in place of more organised outcome-focussed care. However I am sure that many of our members who have been working in the hospital system using capitation models for years may have something to say about that. Research was presented that capitation models in primary care have been shown to increase the flexibility of service delivery by removing set consultation fees, session lengths, group service ratios, and opening up opportunities for telemedicine, telephone counselling and more e-health.
However the primary concerns about the model are that the funding may not be enough, and the ‘disease specific’ nature of the model may commit this program to the same fate as the previous EPC, diabetes group items and Lifestyle modification programs which DOHA admits are not working. There are also concerns that capitation has the potential to create inequities, and difficulties in defining fair criteria for incentive payments. Despite this, I am encouraged by the fact that there is plenty of lead time to iron out the creases before it is launched.
So I guess the message is, watch this space. This is certainly an exciting opportunity for health managers to keep their eye on.
I would like to thank APHCRI for inviting me to participate, and funding my attendance at the forum.