Healthier Medicare – trial of Health Care Homes

This measure will fund the first stage of the rollout of the Health Care Home model, developed by the Primary Health Care Advisory Group (PHCAG).

Page last updated: 03 May 2016

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Why is this important?

  • This new way of funding care for patients with chronic and complex conditions is one of the biggest health system reforms since the introduction of Medicare 30 years ago. Eligible patients in up to seven Primary Health Network regions will voluntarily enrol with a participating medical practice known as their Health Care Home. This practice will provide a patient with a home base for the ongoing coordination, management and support of their conditions. Patients enrolled in a Health Care Home will nominate a preferred clinician, usually a GP. A tailored care plan will be developed in partnership with the patient.
  • Health Care Homes will include general practices and Aboriginal Medical Services. Health Care Homes will assess and enrol patients according to their level of risk, deliver coordinated clinical care that better engages the broader health care team, enhance patient engagement, and provide de-identified data.
  • The payment system for patients enrolled in Health Care Homes will change, with the introduction of quarterly bundled payments to general practices. Fee-for-service payments will remain for routine non-chronic disease-related care. The bundled payment will provide clinicians with flexibility to accommodate regional differences and individual patient needs.
  • A national rollout of Health Care Homes will be informed by the results of a rigorous evaluation of the first stage of implementation and consideration by Government.

Who will benefit?

  • Chronic disease places an enormous burden on the health system. The rising incidence of chronic disease is a significant driver of Australia’s rising health costs.
  • A trial of up to 200 Health Care Homes will offer services to up to 65,000 people with chronic and complex conditions.
  • Health Care Homes will provide continuity of care, coordinated services and a team-based approach to care according to the needs and wishes of the patient.
  • Health care practitioners will benefit from a payment system that allows them the flexibility to deliver health care in the most effective way for individual patients. Payments will be made quarterly rather than on a fee per service basis.
  • Investing in prevention and management of chronic disease keeps people healthier and out of hospital, easing the strain on the hospital system, and increasing efficiency across the wider health system.

How much will this cost?

This measure will cost $21.3 million from 2015–16 to 2018–19.