Wellnet Integrated Care Program – supporting chronic disease management through private public partnerships

Abstract

Introduction: Public and private funders have a mutual interest in effective chronic disease management at the primary care level due to its potential to reduce hospital admissions. The challenge lies in the complexity of the funding sources in Australia. The government's Medicare system funds general practice on a fee for service basis, Primary Health Networks (PHNs) are government funded organisations commissioning care within local communities while private health insurers (PHIs) fund hospital care and are not permitted to insure GP services. Change implementation: Sonic Clinical Services (SCS), the primary care division of Sonic Healthcare, has implemented a model of chronic disease management that incorporates a pooled funding approach by private and public funders. SCS has partnered with PHNs and PHIs in a collaborative approach to resource primary care in a way that complements the Medicare fee for service structure. Aim of change: The WellNet Integrated Care Program is a suite of GP-led programs providing targeted and coordinated chronic disease management delivered through a Patient Centred Medical Home model which aims to shift the way patients are managed in primary care. The Medical Home approach shifts the epicentre of health care delivery from the clinician to the patient through a redesign of infrastructure, health care team roles and modes of delivering care. Developed by SCS, its unique elements include: Risk stratification according to level of risk and complexity Voluntary patient enrolments cdmNet, a web-based platform enabling care planning in real time across the entire clinical team Dedicated nurse care coordinator Change management support Stepped care approach Data analytics. Target population: There are 5 programs targeting 4 population groups: FeelWell & GetWell - complex multi-morbidity BeWell - multiple morbidities StayWell - uncomplicated chronic disease LiveWell - at risk of chronic disease. Highlights: SCS has partnered with Sydney North PHN and 4 PHIs to fund the BeWell program through 5 general practices in NSW. In Victoria, SCS has partnered with Australian Health Service Alliance, a service company representing a number of small to medium size PHIs, to deliver the program through 6 general practices. The start dates for these practices have been staggered with the earliest centre commencing enrolments in February 2017. The early results have included demonstrated improvement in care coordination, patient engagement and achievement of patient identified goals. Conclusion & discussion: The timeline for the program is 12 months with a formal independent evaluation undertaken at the conclusion of the pilot study. This funding model is sustainable as it is designed around the MBS funding system with affordable investment by PHNs and PHIs. The model is transferable to other partnerships who share the will to properly fund chronic disease management. Lessons: Lessons were learned around addressing different PHIs needs and expectations and finding consensus in the approach. Having a fully developed WellNet program with detailed workflows, costings and change management processes has proved to be the key to getting all the stakeholders on board.