What’s ahead for Chronic Disease Management?
Given the ageing population and the increasing incidence of chronic disease, Health Minister Peter Dutton has sent some strong signals that there may be a funding announcement in the Federal Budget on this topic.
The AMA has been calling for additional support for patients with chronic disease, targeting those with higher levels of clinical need.
The AMA has been in regular discussions with the Government and the Department of Health over several years, with the Department floating a range of options including restructuring the Chronic Disease Management (CDM) MBS items, the concept of the medical home, patient enrolment, capitated payments and so on. In addition, the Diabetes Care Project has been running now for a couple of years, and is due to conclude on 30 June this year.
On Budget night, I would hope to see a move to a model of care such as the DVA’s Coordinated Veterans’ Care Program, which provides for GP-led comprehensive and coordinated care for patients with complex and chronic disease who are at significant risk of hospitalisation. It retains fee-for-service, but provides extra funding for proactive management of these patients. It avoids the risks of capitation and patient enrolment and represents an up-front investment in primary care, leading to better patient outcomes and lower downstream hospital costs.
There is no doubt that existing chronic disease management items could be improved. Data on CDM item claims show us that the current structure sees almost every GP Management Plan result in a Team Care Arrangement, and that very few reviews are undertaken.
There could be a number of reasons for the low number of reviews. Perhaps the patient has passed on or moved away. Perhaps, rather than contending with the red tape requirements of billing the review item, GPs are doing the reviews and just claiming a consultation. Perhaps the current structure places undue emphasis on the front end of the chronic disease management process rather than across the care continuum.
With quality chronic disease management more about longitudinal and ongoing monitoring, review, management and care, this data indicates that something needs to be done to ensure that patient progress against the plan is reviewed.
The AMA has been prepared to discuss the restructure of items with the Government in the past, highlighting that any changes should focus on funding high quality longitudinal general practice care, cutting red tape and supporting streamlined access to GP referred services.
The AMA has also highlighted that private health insurers (PHI) need to work more closely with general practice to improve care for PHI members with complex and chronic diseases, including through the provision of funding for GPs.
We do not know what is in the Budget, but if the Government is looking to improve health outcomes for patients with chronic disease, reforms will need to focus on better supporting GPs in caring for patients.
I will certainly be looking to see whether the Government has been listening to the AMA, and judging any reform proposals in the context of the type of ideas outlined above.
Published: 13 May 2014