Outdated, fragmented funding streams are hindering implementation and evaluation of integrated care models.
Local health district funding models can’t keep up with the innovations and complexity of the multidisciplinary care needed to reduce the burden on the NSW hospital system, an inquiry has heard.
Appearing before the NSW Special Commission of Inquiry into Healthcare Funding, Murrumbidgee LHD executive director of integrated care Emma Field said current funding models were unable to capture the complexity of “gold standard” multidisciplinary care
“These new models of care where we’re talking about multidisciplinary teams working with one patient, they’re new, they’re innovative, we have seen reductions in ED presentations,” said Ms Field.
“However, they do give rise to some complexity in funding.
“Let’s say one person in Wagga is seeing one patient in the morning. They then go back to the community setting because they are going to have a one-on-one with that patient in the primary care setting with the GP. That’s counted as one occasion of service.
“Then they might go and organise a dental appointment for that same patient, or they might organise something with another social care provider that gets wrapped up into one service event for the day, even though there have seen three or four interactions for the patient.
“The system has to catch up with [its] funding mechanisms and how we look at outcomes.
“These programs – we know they work well – however for us to truly recognise their value, we have to be able to look at the complexity and fund complexity.
“We need to be flexible enough in these care pathways to divert where we might need to go out to tender, for example, for a particular skill set, we might need to go out to an existing provider in the district to provide that as opposed to onboarding a staff member to do that.”
Ms Field said collaborative commissioning and interactive care models were the “gold standard” for addressing access gaps to primary care and reducing ED presentations but workforce challenges and outdated funding models hindered their implementation.
While evaluations of collaborative commissioning and integrated care initiatives, such as NSW Health’s integrated care ED to community initiative, were still in the early stages, Ms Field said the programs had already demonstrated considerable improvement in increasing access to GP services and reducing ED presentations across western NSW.
“[Looking] at ED reduction across the clusters, we have seen in Deniliquin a 54% reduction in ED presentations after their engagement with the program,” Ms Field said.
“In Wagga we’ve seen a much bigger reduction of 78%, because we have a bigger group of people in Wagga that we can measure against.
“Many of these people don’t have a GP for a variety of reasons, so they may have become very complex and they need more coordination of their care.
“This is one of the programs that I can say, hand on heart, you’re seeing some real benefit to communities who have never had access to the services.”
Workforce challenges and the ongoing systemic burden created by the covid pandemic were also a major barrier to implementing the integrative care and collaborative commissioning models, Ms Field said.
“We’re getting three years in collaborative commissioning to fill these gaps and deliver these pathways [but] we need to have flexibility in that system,” she said.
“For example, we planned that we would hire certain professionals which hasn’t happened for various reasons around workforce challenges, so we have a different way of delivering that particular care pathway but that will lengthen that process.
“It’s going to take a little bit longer to see the biggest bang for buck.”