Lessons from the Trialling allied health service models supported by the MBS projects Kim Marr and Diana Herd General Practice & Service Improvement Team MBS-billed services in community health workshop 31 August 2011

Purpose of the trials What we set out to answer: models for high quality and accessible services most suitable client conditions seamless service

Framework for models

Evaluation results

Absorbed Costs In surplus In deficit Major Surplus Breakeven Major Deficit

Financial/business Viability Payment for assessment/1 st session Getting referrals & GP engagement Insufficient rebate Quality of client care 5 visits not enough Competition for 5 visits Clinical governance & monitoring Goal of seamless care Staffing Contracting process Integrating contracted staff Change management with existing staff – culture shift Understanding of MBS by staff Implementation Project management too time consuming IT difficulties Key issues identified in trials

Financial/business Viability Payment for assessment/1 st session Getting referrals & GP engagement Insufficient rebate Quality of client care 5 visits not enough Competition for 5 visits Clinical governance & monitoring Goal of seamless care Staffing Contracting process Integrating contracted staff Change management with existing staff – culture shift Variable understanding of MBS by staff Implementation Project management too time consuming IT difficulties Key issues identified in trials

Lessons learnt re implementation Initial steps critical –promote relevant understanding of MBS eg training –GP & PN engagement, division support, establish value – needs analysis – workforce – processes & supporting systems Internal change management Ongoing engagement of GPs –early evidence –clear communication (eg waiting lists, feedback) Realistic about limitations of MBS –adapt practice –mixed state-funded/MBS models –co-payments –client/model fit

Twelve months on from the trials……… Approximately 4,520 additional consultations in last 12 months Most agencies maintained or expanded services –one agency reduced services 3 out of 8 agencies operating at a breakeven level –other five agencies operating in deficit Key positive experience – increased service access Key negative experience – not achieving viability (for those agencies that haven’t)

Resources MBS flipchart (online – shortly to be updated) Client services through Medicare. Opportunities & challenges Guide to developing an optimal business model for general practice in community health Working with general practice position statement Guidelines for feedback to general practice Report on Trialling allied health services supported by the MBS (arriving soon) Victorian Service Coordination Practice Manual

Contacts Diana Herd Kim Marr Senior Policy Officer & lead re MBS service models Manager General Practice & Service Improvement