The business of integrated care: implementing new models of care in a fee-for-service setting

Abstract

Purpose The Western New South Wales Integrated Care Strategy (ICS) was rolled out from November 2014 across three rural sites. The purpose of this paper is to assess its impact on general practices, and examine the feasibility of implementing an ICS, within a predominantly fee-for-service delivery model. Design/methodology/approach Mixed methods were used to analyse the implementation of the ICS, including practice-level patient data on changes in service provision. This includes unit-record data on 130 enroled patients across three rural sites, as well as qualitative data collection from providers. Findings There were significant increases in both revenue-generating and non-revenue-generating activities (primarily care coordination activities) associated with implementing the ICS. Each occasion of service involved greater contact time with practice staff other than GPs, as well as greater administration time. There is evidence that ICS activities such as case conferencing and team care planning substitute for traditional GP consultations. Overall, the study found that a significant investment of resources – namely staff time devoted to a range of activities – was required to support the implementation of the ICS. Such an investment was supported both externally and through revenue-generating practice-level activities. Research limitations/implications The data collection and evaluation project is ongoing, with analysis based on the first wave of data from three sites. Practical implications At the practice level, a substantial commitment of resources is required to invest in, and sustain, a new model of integrated care (IC). This commitment can currently be supported both through higher revenue generation at the practice level, and externally by health system stakeholders, but changes in financial settings could impact on financial viability. Originality/value This paper provides evidence on the role of blended payment mechanisms in facilitating the implementation of IC in a rural setting where there are medical workforce constraints.

Continuity of care for patients with chronic conditions from rural or remote Australia: A systematic review

“…From a total of 536 unique studies identified across five databases and reference lists, 12 studies satisfied the selection criteria. [13][14][15][16][17][18][19][20][21][22][23][24] What is already known on this subject:…”

“…Based on the findings herein, it is recommended that when implementing a shared care model, it is important to manage unintended barriers. 13,14,19,22,24 Communication between health care professionals is required to: educate providers on the function, importance and urgency of discharge summaries 20 ; increase the awareness of local services and referral systems 15,16 ; ensure adequate training in the use of technology 13 ; facilitate a detailed documentation to manage the risk of knowledge loss associated with turnover in regional care providers 19 ; and promote the collaboration between providers to ensure consistent data collation and access, treatment, management, advice and enhanced continuity of patient care experiences. 21 To encourage collaboration and respect, rather than competition between health service providers, the role of each care provider should be clearly defined and communicated to minimise gaps in the continuity of care or disputes potentially arising related to responsibilities for tasks.…”

“…13,16-18 Access to Indigenous health practitioners with cultural understanding was noted as an essential facilitator to improve continuity of care for Indigenous patients. 13,24 A lack of availability of technology was sometimes seen as a barrier to achieving continuity of care within the rural areas. 13,17,18,23,24 For example, telemedicine services, provided within a shared care model, can be expensive and not covered by Medicare.…”

“…While several studies suggested that poor communication and coordination were barriers to achieving continuity of care within rural areas, [14][15][16][17][18] others reported that good communication between professionals facilitated collaborative care. 13,14,19,22,24 These studies recognised the importance of sharing information between health professionals and maintaining regular contact with patients. Most of these studies also reported that having a dedicated role specific to the coordination of care improved the collaboration between health care providers.…”

“…15,23 Five studies identified lack of funding and the costs associated with shared care services as a barrier. 13,17,18,23,24 For example, telemedicine services, provided within a shared care model, can be expensive and not covered by Medicare. 13,24 A lack of availability of technology was sometimes seen as a barrier to achieving continuity of care within the rural areas.…”