How many Health Care Homes would be enough?

The Health Care Homes pilot program is still in its early stages so it’s premature to draw any conclusions.  However there is one policy aspect that deserves attention.   How many Health Care Homes does the country actually need? 

During consultations with GPs as part of HCH readiness I was sometimes challenged by GPs who were strident in their belief that the Commonwealth would ultimately coerce their practices to become Health Care Homes, whether they agreed with the model or not.  As one GP reminded me, civil conscription was tested and rejected during World War 1 so in his view, under the constitution, the Commonwealth had no business telling him how to treat his patients.

This is something I could not respond to but it started me thinking about what the HCH scale-out would look like, assuming the initiative was evaluated favourably.  Not every practice is going to embrace the HCH model for a variety of philosophical, logistical, business and personal reasons and I am sure that this reality is not lost on anyone working on this key reform.  So pragmatism and compromise are indicated but what might this actually look like?

Personally I don’t think that we need every practice in Australia to become a HCH.  I think that we need enough Health Care Homes, sufficiently geographically distributed, with enough capacity, to carry the increasing population burden of people living longer with complex chronic conditions.  

This pragmatic approach would make the HCH initiative implementable,  as it provides opportunity to side-step what would otherwise be mass objection.

What do you think?  It would be good to hear the perspectives of others working in this space?

If the theory of disruptive innovation holds what will happen over time is that patients will self-select those practices best suited to their needs – and I think the cash-strapped hospitals will play a part in ‘ushering’ their frequent presenters into HCH settings for obvious reasons.   Taking this to its logical conclusion, what we might see in 10 years time is an established group of HCHs happily caring for enrolled patients with complex care needs and a “rump” of practices focussed on the provision of traditional MBS services to those people with episodic needs- i.e. most people.

Of course, for this to happen we would need to see differential payment systems that saw those HCH practices doing the ‘heavy lifting’ preferentially remunerated over those practices choosing to remain with the current model which is predicated on high patient throughput – “6-minute medicine’ as described somewhat unkindly by other commentators.  The business case for this is favourable when one takes a whole-of-system perspective and the significant savings that might be made in avoidable hospitalisations.

We are starting to see the discourse within the profession mature as GP thought-leaders are stepping up to re-imagine Australian primary healthcare in the 21st century.  Indeed we need to thank the RACGP for advoacting the trialing of patient-centred models of care which ultimately helped shape the HCH model being piloted. The Osana model, pioneered by Melbourne GP, Dr. Kevin Cheng, is well worth taking the time to become acquainted with.

Thought starters:

  1. Do you think that every practice in Australia should become a Health Care Home?
  2. What about rural General Practices serving small communities?  – they are Health Care Homes by default I suppose!
  3. Can the HCH model of care meet its full potential without ‘hard-wiring’ patient integration with local acute hospitals?   – watch out for a blog post on this in the next few weeks.