Australia’s health system is under increasing pressure to provide better quality, affordable and accessible health care, built on universal access to Medicare. A long term strategy for the health system is needed, including providing better management of patients with complex and chronic conditions, eliminating waste and improving efficiency.
To support this endeavour, a Primary Health Care Advisory Group (PHCAG) was established to examine opportunities for reform. The PHCAG provided its report to Government on 3 December 2015 recommending the implementation of a Health Care Home model of care for patients living with chronic and complex health conditions.
As part of the 2016-17 Budget, the Government announced the Healthier Medicare: Reform of the Primary Health Care System package. The core element of the package was the staged rollout of Health Care Homes in selected Primary Health Network regions over three years to 2018-19. To support the introduction of the Health Care Home model during this first stage, a two tiered governance structure consisting of an overarching Implementation Advisory Group (IAG) and four specialised working groups, is to be established to provide expert advice on implementation of the model.
Role and meeting schedule
The role of the IAG is to work collaboratively with the Department under the direction of the Chair to provide advice on issues relevant to the design, implementation and evaluation of the Health Care Home model.
The IAG will be supported by time limited working groups, tasked with guiding the development of core elements underpinning the rollout of Stage 1 Health Care Homes, including payment mechanism, patient identification, guidelines and training, and evaluation. The working groups will have a much more operational focus than the IAG and will be guided by and report to the IAG. Meetings for all of the groups will consist of a mix of face-to-face meetings in Canberra and teleconferences.
The IAG and working groups are advisory, rather than decision making bodies. Decisions on implementation ultimately rest with the Secretary of the Department of Health. The roles, deliverables and anticipated meeting schedules of each group are as follows:Top of page
Health Care Homes IAG
The IAG will be established to oversee implementation of Health Care Homes at Stage 1 sites. This includes:
- providing advice on key implementation issues;
- ensuring that the work program of each of the working groups is aligned with broader policy goals;
- reviewing recommendations of working groups;
- providing advice on stakeholder engagement strategies; and
- provide ongoing evaluation of the implementation process and identify areas of improvement.
The Health Care Homes IAG is scheduled to meet face-to-face six times in 2016-17, four times in 2017-18 and twice in 2018-19. Additional meetings, both face-to-face and via teleconference, will be arranged as required.
Payment Mechanisms Working Group
The Payment Mechanism Working Group will be established to oversee development of payment mechanisms supporting Stage 1 rollout of the Health Care Home model. This may include:
- recommending major underpinning principles to guide the development of Health Care Homes payment mechanisms;
- provide advice on the development of the following major activities:
- apportioning the quantum of available funding against each payment type (by risk tier) drawing on detailed modelling work;
- drafting of comprehensive payment model definitions, descriptions and guidelines; and
- drafting of detailed compliance mechanisms.
The working group is scheduled to hold up to three face-to-face meetings and five teleconferences in 2016-17. The exact number and structure of these meetings will be arranged as required according to the needs of the project. This group is expected to complete its work program in 2016-17. No further meetings are expected beyond this time.
Patient Identification Working Group
The Patient Identification and Risk Stratification Working Group will be established to oversee the development of a ‘case-finding’ instrument for providers, consistent with the PHCAG recommendation to better target chronic disease management services. The Working Group will inform the specification of an instrument that will:
- determine patient eligibility for enrolment in the Health Care Home; and
- attribute a risk score to eligible patients, which will inform value of periodic bundled payments to providers.
The Working Group will provide guidance on a market approach to develop the instrument and provide assistance to the Department of Health with procurement processes, if appropriate, such as:Top of page
- tender evaluation; and
- supporting consultants with advice, guidance and review of contract deliverables.
The group is scheduled to hold three face-to-face meetings and five teleconferences in 2016-17. This group is expected to complete its work program in 2016-17. No further meetings are scheduled beyond this time.
Guidelines, Education and Training Working Group
The Guidelines, Education and Training Working Group will be established to provide expert advice to the IAG to support implementation of Stage 1 roll out of the Health Care Home model. This includes:
- developing guidelines for Health Care Homes;
- developing templates to support patient enrolment, care planning, care review and care coordination;
- adapting clinical and practice management software to support the new service delivery and payment models;
- developing a Health Care Home training curriculum and delivery of education to practice staff;
- provision of practice support to help participating practices to manage transition to the new model of care; and
- fostering communication and information sharing with clinicians, practices, health providers, consumers and their carers to facilitate their engagement with the new model of care.
The group is scheduled to hold four face-to-face meetings and approximately six teleconferences in 2016-17. This working group is expected to complete its work program in 2016-17 and no further meetings are scheduled beyond this time.
Evaluation and Data Working Group
The Evaluation Working Group will be established to oversee all aspects of the design and conduct of an evaluation of Stage 1 roll out of the Health Care Home model. This includes:
- providing expert advice on all aspects of data collection, data analysis and evaluation of the Health Care Home model, including:
- identifying expected changes as a result of the model;
- determining research questions for the evaluation;
- defining a program logic for Health Care Homes;
- identifying existing data sources;
- determining additional data requirements; and
- determining evaluation methods and techniques.
- providing assistance in the drafting of tender documents and contracts for the development of an evaluation framework, the conduct of an evaluation and any related data collection and analysis;
- supporting consultant(s) and reviewing contract deliverables; and
- reporting regularly to the Health Care Homes IAG.
The group is scheduled to hold three face-to-face meetings and five teleconferences in 2016-17, and two face-to-face and two teleconferences in 2017-18 and 2018-19 respectively.
Working Groups will be required to prepare short written reports for each IAG meeting, detailing progress on implementation of their respective elements of the Health Care Home model. The reports will also be used to seek IAG advice/approval on key decisions.
The IAG will report to the Secretary and the Minister as required throughout the process. Top of page
The IAG will be chaired by the Deputy Secretary of Strategic Policy and Innovation Group, Department of Health.
External Members are appointed as individual experts, but will be expected to drive interest within their respective sectors to support the introduction of the Health Care Home model.
Members will be required to sign confidentiality agreements and declare any real or potential conflicts of interest at the commencement of each meeting.
If needed, and with the agreement of the Chair, other non-ongoing participants may be invited to meetings where their input is required on specific matters.
A comprehensive communication strategy will be implemented to support the introduction of the Health Care Home model. It will include a range of communication mechanisms including those established by and for peak organisations, PHNs and health sector media. Communication will be supported by a central website and portal for providers.
State and Territory governments are key stakeholders and will be fully engaged. They have specific expertise as systems managers and have access to unique data sets and a range of analytical and planning tools and are also trialling a number of innovative service delivery approaches which the IAG and respective working groups should leverage where appropriate.
Terms and Conditions
The IAG and working groups will be departmental non-statutory committees and will be managed according to the Department’s External Committee Framework.
Conflicts of Interest
Members shall declare any real or potential conflicts of interest in relation to specific agenda items for meetings of the IAG and working groups.
- The opportunity to do so must be provided at the start of all meetings. All declarations must be recorded in the minutes of the meetings.
- A member who has declared a real or potential conflict of interest may participate in the discussion on that matter, subject to the approval of the respective Chair.
- Any decision reached by the respective Chair under a real or potential conflict of interest will be recorded in the minutes of the meeting. The Minutes will include:
- the nature and extent of the conflict;
- an outline of the discussion; and
- actions taken to manage the conflict.
As detailed above, the IAG and working groups are expected to meet a number of times throughout the process. The chair of the IAG and chairs of each working group will have discretion to call additional meetings and determine the meeting schedule as required.
It is expected that all face-to-face meetings will be held in Canberra or via teleconference as required.Top of page
The following rules apply to the IAG and working group members:
- a member may resign by notice in writing given to the department, through the respective Chair;
- the IAG and working groups may act as long as a quorum (half the IAG or working group membership plus one) is present; and
- should the IAG and working groups not be able to reach a consensus, the respective Chair will have responsibility for a final decision.
The Department will provide support to the IAG and working groups with regard to:
- secretariat services;
- procurement services to support the development of essential infrastructure;
- data and evidence identification and analysis;
- modelling of options identified by the working groups; and
- other expert advice as required.
It is expected that the IAG will continue to exist until 30 June 2019, unless otherwise determined by the Department or Minister. The working groups will be operational for the time periods outlined above.
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