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New model improves patient access and streamlines GP workload

Thursday, 17 May 2018  
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eHealthNews editor Rebecca McBeth


Health Care Home is a new care model that uses technology to “support general practice to be the health care hub and care co-ordinator for its enrolled patients, acting as the system integrator with the patient at the centre”. eHealthNews editor Rebecca McBeth looks at its development.


Pinnacle Midlands Health Network started thinking about a new way of delivering primary care in 2008 when it became obvious that workforce capacity was not going to keep up with growing demand and patient expectations for healthcare.


Health Care Home is a model of care based around a series of core principles, including improving access by offering alternative options for patients via email and telephone, targeting face-to-face consultations to those who need them most and proactive care planning for all patients.


Pinnacle covers 92 practices serving 450,000 patients, and 15 of those practices are using the HCH model. The Midland region covers the Bay of Plenty, Waikato, Lakes, Tairawhiti and Taranaki DHBs.


Under HCH, a Patient Access Centre in Hamilton handles incoming calls to practices, totalling around 1600 calls a day. Only around two per cent of patients abandon their call with no answer, compared to an average of more than 18 per cent.


More than half of patient calls are managed by PAC staff, who have access to the practices’ patient management system, and 62 per cent are managed in ways other than a face-to-face appointment with a doctor or nurse, with most instead getting advice on the phone.


A new system


Chief executive of Pinnacle's innovation arm Ventures, John Macaskill-Smith, says the ability to answer more incoming calls via the PAC is important because previous studies tracked those patients who could not get through to their practice and found they were often turning up face-to-face or going to ED.


He says the model involves GPs having time set aside to call and email patients when necessary, as they are the best qualified to determine their patients’ needs.


Also, the model enables pushing more of the health interactions online via use of a patient portal, including giving patients access to their medical records and allowing them to directly message their GP.


“That’s better for the patient and frees up the day for the clinician so they are not seeing people back to back, and if the patient does come, the doctor knows who they are and why they are coming, and they try not to make them wait,” says Macaskill-Smith.


Another core HCH principle is “moving to a shared cloud-based patient information system to enable timely care and effective co-ordination of activity,” the HCH website says.


Some practices are using a new cloud-based practice management system, Indici, which Pinnacle has developed in conjunction with IT company Valentia Technologies to support the HCH approach.


“It’s API-based, very modern and light and can be used on any device anywhere,” Macaskill-Smith says.


“It can also provide different views to different provider groups, so they can access one aspect of the patient record, as long as the patient is happy for them to do it.”


The benefits


A new EY report, Home Care Health evaluation – updated analysis, compares health utilisation rates by patients at HCH practices with patients at comparable practices with a traditional model of care.


Findings show 20 per cent fewer avoidable hospital admissions, a 32 per cent decrease in ED presentations in over-65s, fewer referrals to specialist care and 62 per cent of same day appointment requests managed without the need for a visit that day.


The impact has been particularly significant for vulnerable groups such as Māori and the elderly.


“These findings suggest that a significant proportion of acute need is being prevented or successfully dealt with out of hospital by HCH practices,” the evaluation report says.


“The associations for Māori, highly deprived and elderly populations suggest the model is pro-equity and has its greatest effects on populations with the greatest needs.”


EY estimates the cost savings to the health system at $2.9 million per year, with only nine per cent of the Midland DHBs population covered and says that if 75 per cent of practices adopted the same models of care, up to $25 million could be saved on hospital costs in the region per year.


“Clinical time was freed up through improved triage and management of patients through means other than face to face consultations. This time was then available to ‘reinvest’ in long term condition patient care,” the report says.


Usage of patient portals is also higher among patients at HCH practices, where over three months from April to June 2017, 12 per cent of HCH patients accessed their portal, while only one per cent of non-HCH practice patients did the same.


A more satisfying day


John Morgan, a GP at NorthCare Pukete Road practice in Hamilton, says a 15-minute appointment at the GP can take two hours out of somebody’s life by the time they have managed to get through on the phone, driven to the practice, waited to be seen and gone home again.


“From a customer patient perspective, we need to be sure that somebody needs to come in before taking that time out of their day,” he says.


“We’re also aware that the demographic modelling shows that if we continue with the traditional model of care, demand will outstrip supply really quickly. That means we have to get doctors to do more face-to-face consults in the day and quality will go down,” Morgan adds.


He says HCH requires a change in the business model of practices, as telephone consultations are charged at lower rates than face-to-face appointments, and email consults only incur a charge if a prescription or other action is needed.


However, he says this allows for efficiencies in other areas and enables the practice to reallocate resources to other areas. NorthCare redesigned the practice around the HCH model and now has a waiting room that is one quarter of the size and is rarely full.


Alongside the financial benefits, he says patient care has improved and staff are much happier in their working days.


“I’ve moved away from the unprepared frenetic mess that my day used to be to a much more planned and calmer day, and I’ve got more time with the patients who need my time because of their complex needs,” says Morgan.


John Macaskill-Smith will be a speaker at HiNZ 2018 from 21–23 November in Wellington. Read more about the HiNZ Conference - click here >>


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