bs_bs_banner
Aust. J. Rural Health (2016) 24, 287288
Editorial
Patient-centred health care homes in Australia: Disruptive
innovation?
In late 2015, the Primary Health Care Advisory Group
(PHCAG) endorsed a new model of care for chronic
disease in Australia the Health Care Home.1 In
media releases issued in March and August 2016,2,3
the Australian government promised to revolutionise
the care of patients with multiple chronic conditions.
The August media release announced a trial which
would cover 10 regions, 200 GP clinics and Aboriginal
Medical Services and up to 65 000 patients, those
who consume over 60% of Medicare costs.3
The Health Care Home has been introduced in a
number of countries and has different names to suit
particular purposes, interests and contexts such as the
Medical Home and the Patient-Centred Health Care experience for the patient. Finally, there will be a vari-
Home. It has a number of elements: patients are co-
producers in their own care; care is provided by a
multidisciplinary team within a bio-psycho-social
model; services to patients are coordinated across the
system; and care is provided using the full range of
delivery channels including face-to-face, telephone and
telecare. The system relies on evidence-based pro-
grammes, data-informed quality improvement and
requires the alignment of payment mechanisms with
outcomes.
Readers of this journal will be aware that while this
approach might align reasonably with the best Aborig-
inal Medical Services, it does not fit well with normal
fee-for-service general practice metropolitan or rural
Australia.
The use of the word revolutionary in a press
release issued jointly by Prime Minister and Minister
of Health implies some measure of disruption to nor-
mal practice and it is worth considering the nature
and likely extent of that disruption and the benefits
that might be achieved.
There is an extensive literature on the subject of dis-
ruptive technologies4 and the impact of new technolo-
gies or service models on existing businesses, some of
which have lost market dominance, such as Kodak, or
ceased to trade. Often the new technology, think digi-
tal cameras, might seem technically inferior at first but
might meet the needs of most consumers and as
demand increases is likely to match or exceed the tech-
nology it replaces.
For some patients with chronic diseases, the purpose
of general practice is to provide a referral to a special-
ist, usually medical, who they think best able to
2016 National Rural Health Alliance Inc.
manage their care. For many, the convenience of the
general practice is a better option and the Health Care
Home with the promised enhancements might add to
those attractions.
What then are the enhancements? The patient
focus promises that the patient and their family will
be co-producers of care, that is tailored to their per-
sonal needs and values. They will have a named clini-
cian, not necessarily a doctor, who is responsible for
their care. Their care will be provided by a compre-
hensive, multidisciplinary team of allied, and perhaps,
social care professionals. This team will coordinate
care across the delivery system promising a seamless
ety of channels for communication within the HCH.
At a minimum this might include visiting the practice,
receiving a home visit, communication by telephone or
email and the use of teleconferencing or web-based
services.
Such enhancements imply a shift in balance from
provider-centred to patient-centred care but a number
of questions arise including: why is the HCH being tri-
alled here and now; what changes to practice systems
and patterns of care will be needed if the trial is to be
successful and how long will it take; and can learnings
from a successful trial be scaled up across Australia
and transform care in rural communities?
It would be hard to dismiss health system cost pres-
sures and the desire to avoid hospitalisation as a
potent motive for trialling HCHs although most
authorities see primary care as the prime location for
care of people with chronic diseases.5 The biggest
change within general practices might prove to be the
development and empowerment of a multidisciplinary
team in which each member collaborates and works to
the full extent of their skills and experience. This will
be further complicated by the limitation of the pro-
gramme to patients with two or more chronic diseases.
Practices might adopt a two-stream service in which
normal service is provided for patients without chronic
diseases and enhance care for some.
Determining the success of the trial will be a com-
plex business. If the HCH is to become normal service
for patients with, and perhaps without, chronic dis-
ease, the trials will have to meet a number of objec-
tives including better clinical outcomes, patient and
provider acceptability, benefits to the system such as
doi: 10.1111/ajr.12333
288
avoidance of hospitalisation, and increased efficiency
and convenience.
All this needs to take place alongside other poten-
tially disruptive technologies. Health information and
advice is increasingly available through the Internet,
247 with no appointment, minimal direct costs and
might be supplemented by online consultations of
varying quality. It might be expected that this and
similar markets will become increasing popular in the
future.
I have raised more questions than answers. As a dis-
ruptive technology, the HCH trial, if successful, might
act as a lever to transform Australian primary care. It
is also possible that Internet-based developments with
all their risks will gain significant market share and
prove to be even more disruptive. We shall see!
References
1 Primary Health Care Advisory Group. Better Outcomes
for People with Chronic and Complex Health Conditions.
Canberra: Australian Government, 2016.
EDITORIAL
2 Prime Minister The Hon. Malcolm Turnbull MP and Min-
ister for Health The Hon. Susan Ley, Joint Media Release,
A Healthier Medicare for chronically-ill patients. Aus-
tralian Government, Canberra, 31 March 2016.
3 Prime Minister The Hon. Malcolm Turnbull MP and Min-
ister for Health The Hon. Susan Ley, Joint Media Release,
Chronic care finds new home in Medicare. Australian
Government, Canberra, 24 August 2016.
4 Christensen CM, Bohmer R, Kenagy J. Will disruptive
innovations cure health care?. Harvard Business Review
2000; 78: 102112.
5 Bodenheimer T, Wagner EH, Grumbach K. Improving pri-
mary care for patients with chronic illness. Journal of the
American Medical Association 2002; 288: 17751779.
David Perkins
Editor-in-Chief
Email: david.perkins@newcastle.edu.au
2016 National Rural Health Alliance Inc.