Will a new model of primary care deliver better results?

Prosperity Health’s recent involvement in the RACGP’s GP17 conference provided exposure to exciting new insights and ideas in the medical industry. We were fortunate to have hundreds of great discussions with practicing GPs and owners about their practices and financial concerns. We also found some visionary individuals looking to make a significant difference to health care in Australia.

One such person was Kevin Cheng, an Australian-trained GP who has worked as a doctor in Australia, Hong Kong, London and Africa in clinical and non-clinical roles. Kevin is in the process of establishing a new model of primary healthcare. His vision for Australia was very interesting, so I decided to interview Kevin and share his comments with you.

Background to the vision

Kevin heads a group called OSANA (www.osana.care). With the substantial financial backing of a group of like-minded private philanthropists, OSANA is building a new model of primary healthcare aimed at improving outcomes for patients and directly reducing unnecessary hospital admissions.

What sparked this vision is the current unsustainable trajectory of healthcare expenditure in this country. On current trends, Treasury forecasts show that 100% of State Government expenditure will be needed to fund health within 30 years, with private health insurance unable to survive its current downward spiral. With 22% of our population aged 65 or more by 2046 and the costs of managing chronic disease doubling to quadrupling (depending on disease type), the future funding of healthcare looks dire.

Our current primary health model is significantly under-funded, with GP services receiving only 7% of total national health expenditure. The activity-based model employed by most practices rewards high volumes of short appointments, which make it hard for GPs to devote the time necessary to make a substantial impact on hospital admission rates. Experience shows that around a third of hospital admissions would be avoidable with better early intervention.

The OSANA approach

The healthcare model which OSANA is rolling out over the next two years draws from successful experiences of similar approaches in countries such as Spain, Alaska and the US,  where enhanced primary care models have reduced unnecessary hospital admissions by 30% and greatly improved patient outcomes. Kevin explained that OSANA’s model of care revolves around four key components:

  1. Multi-disciplinary team to deliver superior patient outcomes – Each GP in an OSANA centre will head a co-located, multi-disciplinary team whose objective and performance measure is the delivery of superior patient outcomes. Each team will include nurses, allied health professionals, a care co-ordinator and a health coach, all of whom look after a defined group of approximately 700 patients (well down on the standard 2,000+ managed by most GPs).
  1. Patient involved healthcare – Activating patient involvement in their own healthcare through a new membership based, customer experience model. Every patient will be allocated a health coach and a clinical coordinator, be provided access to education classes and community activities and will be able to access their health team via phone, email and video consults. Improved patient engagement will help address adherence to care and medication plans and reduce adverse health events.
  1. Proactive care – A shift away from reactive to proactive care. Patients will receive an extended initial assessment, will be risk-segmented and then their care will be co-ordinated with regular consults (face to face or virtual) focussed on keeping them as well as possible. Health coaches will monitor adherence to plans and the team will collect data each week to inform and adjust these plans.
  1. Funding – Whilst the initial funding to prove the efficacy of this model is coming from the private sector, the longer-term goal of OSANA is to obtain value-based funding from State Governments and private insurers, supported by demonstrated improvements in reduced use of the hospital system by OSANA patients.

OSANA’s model of care speaks to the heart of many of the issues our GP clients share with us, driven by a frustration that the current care model doesn’t allow them to deliver the kind of care they are passionate about. Clearly this new approach won’t suit everyone and indeed OSANA is only looking initially for 20 GPs to staff their four trial practices. It will be 2-3 years before the model can deliver enough data to prove their fundamental objective of reducing hospital attendances.

How does remuneration for GPs work under this model?

OSANA’s approach will be to pay their GP team salaries commensurate with what they could earn elsewhere, supported by a bonus program for patient outcomes. This would obviously have flow on effects to the tax treatment of those practitioners but this would be balanced by possible improvements in job satisfaction, greater skills development and team leadership.

Only time will tell

Reflecting on this model, as a time-poor patient I would find such a coordinated approach to my own healthcare very attractive, particularly if there was someone following me up on agreed plans and with whom I could have more convenient virtual consults. It appears to offer a different pathway to the Health Care Homes model currently under initial trial in Australia. Ultimately of course the model will only be sustainable if OSANA can demonstrate value to Government and insurers, all of whom have been approached and who are watching with interest.

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