More Health Reform and Less Healthcare

Well it seems that the Australian government has decided that the health reform agenda announced in 2010 wasn’t going to get through in 2011, so on the weekend we saw yet another attempt at health reform in Australia. As the federal and state leaders debated the need for a national central pool for hospital funding, another thing seemed to have slipped through, and probably didn’t get the attention it deserves.

Medicare Locals have been increased in number, and hopefully in importance. Primary care is critical to healthcare reform, but more importantly we need to move away from the idea of super clinics where patients go, to virtual clinics in people’s homes where a large part of healthcare can be delivered.

There is a strong similarity between Medicare Locals in Australia and Accountable Care Organizations in the USA. Both are still fairly nebulous, but we are starting to see some definition around them, more so the ACOs than the Medicare Locals, but then again we were always fast followers. They both have the same aims, provide high quality yet cost effective care to targeted populations that are currently both the most expensive and in need of the greatest care. As we explore this opportunity we find that in effect that population is either elderly, or suffering from a chronic disease, or even more likely both!

At the upcoming HIMSS conference in the USA there is a lot of discussion about how ehealth would enhance ACOs. It would be nice if in Australia we explored the link between ehealth and Medicare Locals a bit more. The PCEHR is a good first step, but it is not by any means the end. Working off a common data set sure expedites collaboration, but making healthcare a less episodic and more continuous activity will make a much bigger difference to the outcomes.

What do I mean? Well today we use healthcare services episodically, either when we are sick, or when we have a pre booked appointment to see a clinician. How much better would it be if the system captured information continuously, both subjective and objective, and made it available to the care team to respond to? That would be a much better model of local care than a super clinic, turn the patient’s home into part of a virtual clinic. We should be looking at Medicare Locals as just such an opportunity, not a new bricks and mortar building, but a new way of thinking of care, with reimbursement tied to outcomes and patient satisfaction.

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2 Responses to “More Health Reform and Less Healthcare”

  1. JASON TRETHOWAN Says:

    Hi George

    Your blog highlights some of the confusion being experienced regarding Medicare Locals. They are not medical centres, Super Clinics or community health centres. Unlike the Accountable Care Organisations (ACOs) the Medicare Local will amongst other things be a primary health care network which will plan locally to fill service gaps in the community, enhance service coordination between General Practice and the hospital and Aged Care sectors and coordinate local responses for after hours GP care.

    Medicare Locals will be well placed to work with clinicians and the community to support the uptake of E-Health. The PCEHR is an example where a coordinated response locally will be required to “make it happen”.

    I agree that we have the opportunities to promote the uptake of E-Health in the home. The key will be to have health professionals such as GPs supported to communicate electronically with patient PCEHRs.

    I like where you are going but is it aligned with emerging health policy?

    Cheers

    Jason Trethowan
    CEO, GP Association of Geelong

  2. georgemargelis Says:

    Thanks Jason
    The most dangerous element of the confusion around Medicare Locals is that various groups are heading down disparate paths based on their understanding of what they believe they are.

    The idea of them acting as a primary care network is very interesting as it emphasizes the possibility of a virtual entity that leverages existing infrastructure like GP clinics, aged care facilities and hospitals but enhances them by allowing them to collaborate virtually at a time and place that suits the patient. Adding the technologically enhanced home as part of that virtual network increases the effectiveness further.

    Aligning with current health policy is another challenge. Policy today is still very hospital focussed and is just starting to appreciate the value of the GP and primary care. I still think it needs some pushing to fully include the patient as a key participant and not just the focus for billing and record keeping.

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