We’ve made great progress but we’re ready for more, say experts.
A spokesperson for the Department of Health, Disability and Ageing has told a Sydney conference that progress in evolving Medicare beyond the fee-for-service model was “imminent”.
Daniel McCabe, the DoHDA’s first assistant secretary for Medicare and digital health, told the Australasian Institute of Digital Health’s Primary Care Digitally Connected Conference today that “deep work” was being done.
“We’re doing a lot of deep work at the moment about evolving Medicare from just being a fee-for-service model,” he said.
“It has served us well for 41 years now in terms of delivering fee-for-service, but it doesn’t do a lot of things that we need to do in a modern health system.
“It doesn’t support asynchronous care, where health providers and GP are supporting their patients when the patients aren’t with them.
“What we’re trying to do at the moment is work through how we evolve that, and start to look at blended funding models, taking some of the money we fund through fee-for-service and paying as a base payment to help professionals so they can do things beyond episodic care,” he said.
Danielle Bancroft, owner of Off Label Consulting, said up until now we’ve been funding independent projects, an approach which, for the most part, has been successful.
“But what we’ve ended up with is quite a lot of portals, workflows, and they usually end at phase one and two. But we never actually realise connecting up those systems,” she said.
“What we really need moving forward is to double down, and instead of just talking, start funding the connection side of it to create hubs. That’s the next phase,” she said.
That means the way government allocates funding needed to change.
“The traditional model of fee-for-service doesn’t work in the traditional sense,” she said, suggesting a hybrid model would be more appropriate.
“There may still be some fee-for-service, but there needs to be a shift to other ways of actually looking [at] the primary care model.
“How do we shift that to incentivise things like sharing of data, sharing of patient care, the multidisciplinary models.”
Sharing by default
My Health Record was another area that has seen great progress but still needs some innovation.
Karen Booth, chief clinical adviser for nursing with the Australian Digital Health Agency, highlighted that sharing by default gives consumers the opportunity to think more proactively about their health.
“Hopefully, that will also give us guidance to be more proactive and teach them things like self-care skills so that they can look after themselves, so that they can make better decisions,” she said.
Dr Michael Bonning, a GP and deputy chair of the Royal Australian College of GPs’ expert committee on funding and health agreed. He said the information being provided to patients gave them an opportunity to join with the healthcare professionals in treating their health.
“You, the patient, will become the expert in your own condition, because you’ll be the one who lives with it, not just the numbers on the page or the dense emails from the specialists.
“Part of that is that you know you help us as generalists … to understand some of the implications for you, the individual,” he said.
Mr McCabe said the DoHDA had been able to use Medicare as a lever to require various providers to upload their reports to My Health Record.
But when it comes to the proliferation of private providers working outside the Medicare system, there was a lot of information the Department was not yet able to access.
“Those business models are great. They offer choice for Australians, they offer convenience, they offer access, but they also are unregulated in terms of levers that the Commonwealth has,” he said.
“We want to make sure it’s done in a safe way, and that we encourage continuity of care.
“So, we will be doing some work to uplift professional standards, working with all of the health and medical boards, working with all of our states and territories to make sure we have consistent harmonisation of drugs and poisons legislation.
“There’s a number of digital health interventions which we think will be beneficial not only to those businesses, but to their patients and to the wider health system, which we’ll talk about soon,” he promised.
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The proliferation of AI scribes
Dr Bonning said that while AI scribes had introduced efficiencies and time savings for clinicians, they had also created free text in a clinical system that wasn’t coded or easy to use.
“This space actually has a great name now – it’s called ‘work slop’,” he said. “It’s this idea that rather than the conciseness of a mind that looks thematically and puts things together, [AI scribes are] delivering six paragraphs where I could have had two.”
Mr McCabe said the Department was currently talking to AI scribe vendors about high fidelity coding.
“Some of them are talking to us about getting their products registered as a medical device, because they appreciate [that] when you get into coding, you’re going to need to have that level of fidelity, and that’s important to us for a few reasons,” he said.
“Last year, Medicare funded six million chronic condition plans in general practice, but we don’t have any insights out of that.
“Where we’re going over the next 12 to 18 months, is to codify the way we do those plans in a consistent way. Coding is going to be really critical.
“We want to be able to understand the burden of disease right down into our individual communities, so we understand what interventions we need to do today,” he said.
Ms Bancroft highlighted initiatives like Sparked, are working across sectors to try and solve some of these problems. But more needs to be done.
“We’re now at that point where just a little change isn’t enough anymore. It’s time for that big next step to actually start to shift the scales.”
