nib health funds (nib) and Hunter Medicare Local (Hunter ML) today announced a unique partnership that will see the two leading Hunter health organisations collaborate to deliver a new care coordination program for nib customers with high medical needs.
The pilot program will provide around 100 nib customers with complex and chronic diseases with coordinated care in a primary care setting under the guidance of their treating GP.
nib Chief Executive Officer, Mark Fitzgibbon, said the program is the first time the health insurer has worked closely with GPs to better manage the health of chronically ill customers and reduce unnecessary hospital utilisation.
"Approximately one per cent of our hospital customers account for more than 50% of hospital benefits we pay. This has a direct impact on insurance premiums," Mr Fitzgibbon said.
"It is estimated that Australia-wide, about 700,000 hospital admissions each year are potentially avoidable. nib, other insurers and indeed the public system need to get much more interventional about tacking inappropriate and unnecessary health care and spending.
"By working closer with GPs, such as Hunter Medical Local, we can help our customers better manage their health care needs and also reduce the time they spend in hospital. We expect the pilot to be successful allowing us to look at expanding the program more broadly across our national customer base," he added.
Hunter ML Clinical Services Executive, Dr Kevin Sweeney, said the new program is a model for improving the efficiency and effectiveness of our health system.
"Patients with chronic diseases, such as asthma, cancer, arthritis, diabetes, heart disease and mental illness,currently account for more than 70% of GP consultations," Dr Sweeney said.
"By effectively coordinating their care we can improve their health outcomes and avoid unnecessary hospital admissions.
"Hunter Medicare Local will provide a 'care coordinator' who is a registered nurse to work with the patient to coordinate their care and implement the GP management plan. The services that will be provided by Hunter Medicare Local are designed to enhance the patient's usual care.
"Fundamentally, our aim is to improve the health care and health outcomes for nib customers," Dr Sweeney added.
Hunter ML Chair, Dr Trent Watson, said the collaboration between the two organisations was a practical example of how the health industry can reduce fragmented care and bring health providers together to assist patients to negotiate our complex health system, improve their access to services and improve their health and wellbeing.
"The Federal Health Minister, Peter Dutton, has said that part of the solution to improving our health system is to spend money more efficiently and, where clinically appropriate, treat patients at a primary care level. This new care coordination program is a perfect example of how that can be achieved," Dr Watson said.
"The alarming increase in preventable chronic diseases, such as diabetes, are placing a huge burden on the financial sustainability of the health system and by conducting care coordination programs we can support the patient to keep them well and out of the most expensive part of our health care system; hospitals.
"A key benefit of care coordination programs is that they are patient-centred, which is a key focus of all programs delivered by Hunter Medicare Local. Research has demonstrated that engaging patients more fully in their own health care not only improves the experience for patients and those who care for them, but it also improves the quality of care and lessens the cost to all," Dr Watson said.
nib will work with local GPs and offer eligible, high-needs customers with the opportunity to participate in the program over the next 12 months. Program participants will receive an individually developed health management plan, face-to-face health assessments, home visits, education and health coaching.
Those interested in learning more about the pilot can contact nib on 13 14 63.