Healthcare is vital. Access to healthcare is what we all need when we get sick. But there are gaps in the sector that need to be bridged in order to provide integrated care that is centered around individuals and their communities.
This was the theme of discussion at the 2017 Dean’s Future Health Forum, which was held earlier this month at the University of Sydney. In attendance were more than 170 health professionals and clinicians from across the broad health sector, including disability, aged care and social services.
With “bridging the gap” being front of mind in discussions, there were questions on how to deliver on the promise of universal access to well-integrated care, how to prevent hospital admissions and how to improve coordinations and management of complex and chronic health conditions.
Equity of Access and Improving Access
We’ve got a good quality healthcare system and our consumers have a high degree of confidence in it,” said Mark Cormack, Deputy Secretary from the Strategic Policy and Innovation Group, Department of Health.
“It has universality at its heart and [we need to] build on the strengths.”
There are barriers to good health and provision of healthcare, which include;
- Access to health services in outer metropolitan and regional areas
- The design of the current system
- How it is funded and structured to receive funding
- A disparity in costs across the states
- The Medicare payment model
- Availability of e-health and data
- Access to online health information
IT Connectivity as a Barrier
“I think geography and IT connectivity are two of the significant barriers for us in the delivery of healthcare,” said Deborah Willcox, Interim Chief Executive at Northern Sydney Local Health District.
“There is a disparity between the parts of the health system we can access. If we don’t even have access to data, it makes it very hard to do what we need to do.”
Walter Kmet, CEO of WentWest, suggests that system structure is something that needs to be better analysed, “we need to provide leadership around moving the system to where we want it to be – shifting funding from intervention to areas of the system that are more focussed on prevention.”
“Coordinating and connecting is very important, but transforming the way in which we provide these services to be patient centered and oriented around the person’s needs becomes an important aspect of that.”
According to Cormack, 82 per cent of people go online first for health information about their conditions, the the health system unable to control the quality of information being accessed.
Health literacy is a barrier, as is the absence of a readily accessible source of information about performance and quality in outcomes delivered by the health service itself.
Professor David Currow, Chief Cancer Officer of NSW and CEO of the Cancer Institute NSW, emphasised that transparency and availability of data is paramount.
“Most practitioners have no feedback on their own performance,” commenting that it is vital to provide feedback to individual clinicians as well as consumers.
Kmet pointed out however, that it is the system that need to change before new IT can be implemented, “we need to recognise that IT and e-health is an enabler to a system that we want to be in place, as opposed to a solution.”
Cost Structure and Payments as Barriers
During the panel, it was suggested that cost structure and payment arrangements were another significant barrier within healthcare.
“We have a system where are are just paying people to do things, it’s not based on what they achieve, the outcome or quality,” said Kmet.
Payment doesn’t take account of whether the treatment is “good, bad or indifferent, and whether it has helped, harmed or killed the person”.
Kmet proposed the introduction of a payment arrangement for public hospital care that no longer pays for catastrophic outcomes in healthcare, and offers price reductions for preventable healthcare complications.
“It’s a fraught area of public policy,” said Willcox, “You don’t want to rewards poor performance, but by extracting dollars, it may perversely impact on the organisation’s ability to improve itself.”
When opening to the audience, there was a range of responses regarding how they can build a more integrated healthcare system, suggestions including telehealth and an integrated data system, health records accessible to all practitioners for providing care to an individual, combining health and education, and working on culture change and engagement with communities.
Prevention and Intervention
Primary healthcare, particularly by allied health professionals, is frequently provided in small clinics that are not connected with each other or with the local health district. These small businesses can be equally concerned about their business model and patient care.
At the Forum, ideas that were discussed included incorporating a universal definition of patient-centered care, improving health literacy and consumers’ ability to navigate the system, supporting innovation and communication, maintaining a motivated workforce, the use of shared care plans and sharing information about patients across the care team.
“We have to truly address health literacy and talk to people about how to navigate the system. We’re not funded for it,” said Kathryn Refshauge, Dean of the Faculty of Health Sciences at the University of Sydney.
“Our communication has to be right with people. Culture is everything, I think people get out of bed to deliver good patient care,” added Willcox.
In Western Sydney, Walter Kmet and his team have implemented shared care plans as a part of their integrated care work. As a result, all clinicians enrolled with a patient can view their records across a system.
Kmet believes that funding, capacity and teamwork is required to integrate better care, “I think primary care can become a platform for better integration,” adding that the Commonwealth Government can take ownership through policy, funding and legislation.
“Australia’s healthcare system is a shared responsibility and that’s constitutional. We’re about to have an integrated record system that will for the first time, involve and engage and legislate the citizens.”
Willcox suggested that leadership at an individual level is creating change locally. “There is a lot of innovation and connection across disciplines. I think ideas will rise and people will run with them and make them happen,” referencing the Green Square HealthOne program as an example of health innovation happening at a local level.
Kmet also advocated for grass-roots change at a local level. “One of my roles is looking after the primary health networks, and we’re seeing 31 fantastic examples of regional level leadership and engagement,” he said.
Refshauge added that strategy and leadership is also required to support change led by individuals at a local level.
Complex and Chronic Health Conditions
The burden of disease is rising: there are increasing numbers of patients with complex and chronic health conditions, people with childhood diseases living into adult, and an ageing population.
These issues all pose new funding and healthcare challenges.
The audience was shown a consumer video vignette highlighting the need for case managers and use of shared care plans for management of patients with chronic health conditions.
In terms of what can be done to, there were suggestions of health education, promoting a culture of cohesion and integration among health disciplines, and enabling patients to have greater control over their records and the management of their conditions.
Cormack proposed a four-pronged approach that included:
- A coherent and co-designed evidence-based care model
- Local integration of the model across organisations such as the primary health networks
- A payment system that supports the model
- The technology to allow a shared, personally controlled, e-health record
“If we can get it right in chronic care, then we’re probably getting it right in lots of other areas,” said Currow.
“We need to hear the consumer voice at every health encounter. We need local community solutions and good integration across disciplines.”
Kmet added, “we need to shift investment from the old system to thing that are going to make a difference further down the line: prevention and primary care.”
The important take away message from this forum event was that the responsibility for creating change lies with every person.
It had been advised that health services worth within child care and aged care systems to establish programs and invest in health. It’s also important to think about the types of health jobs being created in the future to attract and retain the best talent.