New Medicare payment model for chronically-ill patients

Upfront and Quarterly bundled payments for GPs being introduced on trial basis.

Medical office - middle-aged male doctor greeting patient, shaking hands.

Medical office - middle-aged male doctor greeting patient, shaking hands. Source: Flickr

In an attempt to overhaul the Medicare payment model, the government has come up with a plan to establish Health Care Homes for chronically ill patients.

The Health Care Homes will be responsible for co-ordinating care for the chronically ill patients who suffer from chronic health conditions like cardiovascular diseases, diabetes and cancer.

Under this trial, the medicare payments can be made upfront and/or in quarterly payments to Health Care Homes.

This will significantly impact the way General Practitioners and nurses who deal with chronically ill patients as the new plan takes away the pressure to bill every item of service delivered.
According to government estimates, a chronically-ill patient sees over 4 to 5 different doctors in a year. Under the new trial, these Health Care Homes will allow patients with multiple chronic illnesses to nominate a GP practice as their ‘home base’.

This practice will would then coordinate a healthcare package tailored to their conditions.

And the Medicare payments for these healthcare packages to General Practitioners will be paid quarterly.

The statement from the Health Department acknowledged this was a move away from Medicare's current fee-for service model: "This will encourage providers to be flexible and innovative in how they communicate and deliver care, and will ensure that the patient's healthcare needs are regularly monitored and reviewed."

Estimates suggest that up to one in five Australians had two or more chronic health conditions, including diabetes, heart disease and cancer.

The new payments system will be trialled and evaluated for two years from 1 July 2017 to 30 June 2019 in up to 200 Health Care Homes representing 65,000 patients.


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By Mosiqi Acharya
Source: Department of Health

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