Summary of Meeting 3 of the Improved Models of Care Working Group 21 August 2018

Page last updated: 18 September 2018

Summary of Meeting 3 of the Improved Models of Care Working Group 21 August 2018 (PDF 136 KB)

Attendees

MembersMembers continued
Dr Jeffrey Harmer AO, ChairDr Stephen de Graaff, Australasian Faculty of Rehabilitation Medicine
Jo Root, Consumers Health ForumChristine Gee, Australian Private Hospitals Association
Janne McMahon OAM, Private Mental Health Consumer Carer NetworkDr Andrew Wilson, Medibank Private (via teleconference)
Belinda Highmore, Mental Health Australia
Andrew Sando, Australian Health Service AllianceSecretariat
Kelly Johnstone, BupaSusan Azmi, Department of Health
Professor John Horvath AO, Ramsay Health CarePauline Dusink, Department of Health
Peter Bailey, Wyndham Clinic Private HospitalMitch Docking, Department of Health

Apologies

Professor Ian Hickie, AM, Brain and Mind Centre, University of Sydney
Marcus Dripps, Allied Health Professions Australia
Associate Professor Graham Mercer, Australian Medical Association

1. Welcome, introductions, and conflicts of interest

  • The Chair opened the meeting and provided members a brief overview of the issues to be considered at the meeting.
  • Members did not declare any new conflicts.

2. Principles

  • The Secretariat introduced a paper outlining the Mental Health and Rehabilitation sub groups’ considerations of possible principles for the assessment of possible reform options, and invited member comments.
  • The principles broadly included the following themes: maintaining independent clinical decision-making; support for informed patient choice; clinical outcomes and best practice care regardless of setting; support for system sustainability; appropriate use of workforce; no unreasonable shifting of costs or responsibilities onto patients or carers; and support for a holistic approach to service delivery.

3. Alternative models

  • A number of members presented on alternative models relevant for private health insurance funded mental health and rehabilitation services, which were discussed by the Working Group. The key areas of discussion are outlined below:
    • Alternatives to admitted hospital-based mental health and rehabilitation services enhance patient choice;
    • Private hospitals have established programs as alternatives to admitted hospital based mental health services, such as hospital in the home and outreach programs. Feedback from private hospitals suggests these programs achieve high clinician engagement and positive patient satisfaction scores. It was acknowledged that these programs improve consumer value and deliver services more cost efficiently at the individual level.
    • Private hospitals identified that existing contracting arrangements are a potential barrier to introducing alternative models. Each private health insurer may include different clinical requirements for mental health programs This arrangement may dampen innovative alternative models as it is difficult for private hospitals to achieve sufficient economies of scale to support sustainable programs. It was proposed that some of these challenges could be overcome with standardisation of programs across industry.
    • Transcranial magnetic stimulation was identified as a mental health treatment that is safe and effective to provide on an outpatient basis, but is currently delivered as an admitted hospital-based service due to the existing funding model. Current pilot projects are seeking to establish a new model of care for private transcranial magnetic stimulation.
    • Findings from recent and current rehabilitation pilot projects, such as rehabilitation in the home projects, suggest the projects deliver good clinical outcomes and positive patient satisfaction at a lower cost than admitted hospital-based rehabilitation.
    • Rates of referral to admitted rehabilitation programs following hip and knee replacements vary significantly by jurisdiction, hospital and clinician, and it was suggested that some of this variation was not clinically justified.
    • Pilot projects have been established in other clinical areas including: palliative care; chemotherapy; and dialysis.

4. Options for change

  • The Working Group discussed a range of possible options to improve the regulation of private health insurance funded mental health and rehabilitation services.
  • The Working Group considered the existing legislation and whether it could be clarified to give certainty to the sector about what is and is not permitted under the Private Health Insurance Act 2007 and Rules.
  • Members generally supported changes that would improve the ability to transition successful pilot projects to ongoing programs and improve the model of care.
  • The Working Group considered whether the Guidelines for Determining Benefits for Private Health Insurance Purposes for Private Mental Health Care 2015 and the Guidelines for Recognition of Private Hospital-Based Rehabilitation Services 2016 could be revised to become more clinically relevant and to reflect service provision in alternative settings.
  • Some members were of the view that there is a large variation of quality in mental health and rehabilitation programs currently being delivered. Standardising programs could benefit providers as they would be able to deliver clinically appropriate programs to patients requiring treatment regardless of the insurer, providing economies of scale for the program. Updated guidelines could help to reduce variation.
  • The Working Group supported improvements in data quality and reporting of private health insurance funded mental health and rehabilitation services.

5. Implementation issues and transition arrangements

  • Members considered implementation issues and transition arrangements associated with possible changes to the regulation of private health insurance funded mental health and rehabilitation services.
  • Key issues considered by the Working Group included:
    • a communication strategy to educate and inform clinicians, providers and consumers on clinically appropriate, best practice care for private mental health and rehabilitation services;
    • industry guidelines for mental health and rehabilitation that are clinically relevant and include guidance on potential alternatives to hospital-based mental health and rehabilitation services;
    • ensuring independent clinical decision-making is maintained, and services are clinically appropriate, best practice care and delivered in efficient settings;
    • ensuring costs and responsibilities are not inappropriately shifted to patients, carers and families;
    • research and monitoring the effect of changes to service delivery, safety and quality, and clinical outcomes resulting from reforms; and
    • support for premium affordability for consumers and sustainability of the private health sector.

6. Other business