Population Health Management – Transitioning beyond Episodic Care

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-By Anne Lindert-Wentzell

“All the pleasures and riches in the world are insignificant when we do not have our health to enjoy them with, so a choice for health and wellness begins within each of us.” These are the words of Diane McLaren. Indeed, maintaining one’s health is the most basic of social virtues. With the demand for health care consistently rising in Australia, the need to meet this demand is paramount for all health care providers.

Managing the health of populations (Population Health) requires a shift from the traditional episodic care (treatment for a particular problem) toward a proactive holistic approach, in which the focus is on prevention. Monitoring population health through a holistic approach advances solutions to the most persistent health issues in the health care delivery system. This holistic approach allows the focus to transition from an “illness” system to prevention and promotion – throughout one’s lifetime.

With 63 Medical Centres and skin specialist clinics throughout Australia, Healthscope Medical Centres (HMC) adheres to the population health approach while incorporating holistic philosophies to enable total health solutions. Since its beginning in 1985, Healthscope has provided innovative, multidisciplinary services to meet the health demands of patients in any given area of the nation. One of HMC’s key strategies encourages patients to take responsibility for their own health, believing that the adoption of such a strategy should be the focus for the primary care industry in general. By adopting a self-care delivery system, patient health progression can be better managed and monitored. Says Lou Pascuzzi, Healthscope Medical Centres National Manager, “I agree that a robust delivery system is absolutely crucial. Healthscope Medical Centres have invested heavily in our 63 practices, implementing systems and processes to ensure a standardised approach to achieving the best possible patient outcomes.”

Service excellence is the first of Healthscope Medical Centres’ STAR values that reflect the organisation’s mission statement and commitment as a group. The acronym also includes Teamwork and integrity, Aspiration, and Responsibility. “We strive to provide the highest standard of health care,” says Lou. “We look for new opportunities to improve our service, and we seek to understand and exceed expectations.”

In the past year, the implementation of additional initiatives has secured Healthscope Medical Centres’ commitment to quality performance. For example, the organisation has upgraded and expanded the quality of its physical infrastructure equipment and facilities. Additionally, now included are such services as continuity of care, indigenous and aged health assessments and chronic disease and multidisciplinary team management, to name a few.

Medical Coordinators have a place in every practice, enabling better outcomes for patients. HMC adopted major sponsorship of the General Practice Registrars Association (GPRA) in an effort to secure the position of Corporate Centres of Choice for GP Registrars, and has achieved AGPAL (Australian General Practice Accreditation Ltd), “something that we’re very proud of,” says Lou. “It’s an external recognition of our quality service.”

The current and long term strategic focus of HMC supports the Primary Care Principles and Agreements direction of the National Healthcare Agreement (2011), produced by the Council of Australian Governments (COAG). “The Agreement contains some worthy aspirations, particularly in the area of prevention, thus very much guiding the way we view our role,” adds Lou. He does indicate, however, that some targets identified in the area of prevention may not be achievable in outlined timeframes, such as reducing the age related prevalence of Type 2 diabetes to 7.1 per cent by 2023. Figures to be released in July of an HMC study conducted in partnership with and endorsed by Diabetes Australia, Queensland, suggest that this may be unrealistic. However, adds Lou, “While the timing to achieve the performance benchmarks in the Agreement may be overzealous, the foci of the agreement are valid, and have provided guidance with regard to our clinical and commercial concentrations.”

Lou reiterates that Healthscope Medical Centres’ goals are consistent with the principles of the National Healthcare Agreement – a move away from the traditional model of episodic care into a model of proactive holistic patient management. Goals such as improving primary care service and reducing the number of preventable hospital admissions to 8.5 per cent by 2014/15 would do much to help alleviate the pressure on the public hospital network.

An estimated 12 million Australians pay into private health insurance. With 2.2 million patients, Healthscope Medical Centres works in conjunction with private health insurers on programs and initiatives to better align its Primary Care network with private health members, offering an alternative to public health care. “This is consistent,” says Lou, “with what we see as our role, particularly in relation to population health outcomes.”

The National Healthcare Agreement does not address plans for future funding of the GP and Primary Care system. It lists current micro initiatives and reforms such as Infrastructure Grants, After Hours Grants and additional GP and Allied Health training, for example, but, “In a country where population growth is expected to reach 30 million by 2030, the responsibility of present day governments should include planning for this, and support for modern General Practice will be vital in meeting this challenge,” says Lou. He indicates that the demand for Medicare funding has grown at an annualised rate of three per cent per year (2006-2011), equivalent to $1 billion. “The government will need to find, on today’s values, which are ultimately over conservative, an additional $4 to $5 billion, at the very least, in the year 2030… Diminishing resources will mandate a renewed and stronger focus on prevention and a re-examination of funding options.”

Lou acknowledges there is a need for more Medical Centres in rural areas. However, Healthscope Medical Centres’ immediate strategic focus is in areas of urban sprawl in major metropolitan areas and in areas of higher concentrations of multi dwelling developments. He says, “Where opportunities to integrate with our hospital and pathology businesses become available in rural locations, we will consider our options.”

In some extreme cases, Healthscope Medical Centres has had to withdraw from a location, but every effort is made to consolidate with a neighbouring Healthscope Medical Centre and to minimise disruption to patient care. Older patients are directed to the most convenient Healthscope Medical Centre, and if this presents a problem, doctors and staff offer the option of home visits. If the patient doesn’t require home visits or the commute is too far, patient files can be transferred to a practice that meets their needs. “Patients and the local community are kept fully informed of any change and are advised of the new location of their preferred doctor,” says Lou, “so they can make an informed decision to remain with a neighbouring Healthscope Medical Centre, or transfer their medical records to a service provider of their choice.”

Healthscope Medical Centres prides itself on maintaining a substantial geographic footprint of Medical and Skin Centres throughout Australia and is constantly expanding its infrastructure to develop multidisciplinary Centres – total patient healthcare management remains the focus. Says Lou, “Our advantage of having an enviable extensive, quality hospital and pathology service network allows us to provide total primary and acute care within the one group. No other healthcare provider in Australia can claim this integrated capability.”

In terms of competition such as GP Super Clinics, Lou doesn’t believe that they pose a threat to HMC’s existing network. He does suggest, however, that the money allocated to Super Clinics “would have been better spent on enhancing existing infrastructure… our practices are protected against this likelihood due to the strength of our corporate infrastructure and the strong relative relationships between our Healthscope Medical Centres doctors, patients and the practice.”

Incorporated into HMC’s vision is attracting and maintaining quality GPs through staff development and refined systems and processes. The Centres stand alone from the competition in that they offer flexible working arrangements, modern facilities, professional development and a consultative operational approach. “Healthscope Medical Centres’ contemporary multidisciplinary service provides GPs with an expanded health care offering, allowing them to extend improved service and care for their patients,” says Lou, adding that, “This helps Healthscope Medical Centres attract and retain a high standard of GPs.”

Healthscope has challenges to meet to maintain its momentum of success, namely in the form of accessing the capital required for expansion, recruitment plans and consolidation. Yet the organisation “remains in an enviable position by having sponsors supportive of our business strategy and its relative growth,” says Lou.

The holistic, multidisciplinary and national primary health care services provider – found in the Healthscope Medical Centres name – ensures a patient focused, quality, accessible network to all Australians. “It’s a totally integrated healthcare management solution,” says Lou, concluding that, “Real success means improved measurable clinical outcomes. This is at the core of population health and our business success.”

Making Sense of Management

Management is the art, or science, of getting things done through people. Sounds fairly straightforward – except for the fact that people are not robots waiting to do our bidding. People have their own minds, motivations, and goals. So how do managers keep operations – and the people behind them – running as planned?

December 16, 2018, 6:45 AM AEDT