14 September 2015

Guest blog by Walter de Ruyter: Transfer of Care for Complex Health Consumers (Part 2)

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Last week's blog looked at changing transfer of care models and adapting consumer expectations and social inclusion and wellbeing. This week, Walter will sum up the blog by looking at introducing new funding models.

Introducing new funding models
There are a number of key funding instruments, Medicare rebates for General Practitioners, ACFI for aged care and Diagnostic Related Groups (DRGs / Casemix) for Acute Health Services. They are performance based funding instruments. To build health capacity they could be adapted in the case of ACFI to fund RN positions in ageing in place services in return for the provider participating in planned care models at point of need. Tools such as pathway mapping already exist and have been successfully used as evidenced by Canterbury Health Services New Zealand following the Christchurch Earthquake.
Registered Nurses in aged care are strong contributors to capacity. Combined with planned events of care at point of need can reduce demand on hospital beds through reduced transfers’ to hospital or earlier transfers’ back to residential and community services through transitional beds with significant savings to the community whilst improving the quality of care for recipients.
The Australian federal government recently restructured Medicare Locals into Primary Health Care Networks. The result has been a reduction in the overall number of Medicare Locals and a move away from direct provision of services to developing a framework of providers meeting the health needs of community groups specific to their health profile and demographic. Consumers in these networks have greater influence as to the use of funding under the auspice of the primary health care network. These primary networks have the future potential to be the key driver as to transfer of care models not only at point of service such as hospitals, but more importantly at point of need such as the persons’ home where ever that may be.
The rate and increase of the aged population creates a strong need for alternate revenue resources such as Social Investment Bonds as a means of funding health and wellbeing services. Financial markets do not have a shortage of capital they have a shortage of safe havens for capital investment. An example of a social investment bond is Newpin the first bond issued in Australia managed by Uniting Services. These bonds are a future revenue stream which is performance based, subject to the rules of commerce and investment rather than the vagaries of the political cycle.

The integration of care between service providers is an essential element in developing the necessary solutions to manage the health and wellbeing of an aging community. This can be achieved when key partners reorientate in unison the physical and social infrastructure of their services to collectively demonstrate a health gain. This strategy of reorientating physical and social capital need only to be minor by each stakeholder but when applied collectively has a significant local impact. The result will free up much needed local hospital beds whilst enhancing the care received by an aging population outside of a hospital setting. A challenge for health and care leaders is how they demonstrate to the community a style of leadership that brings about a whole of community response to promoting the health and wellbeing of an aging population.

Walter will be speaking at the upcoming Transfer of Care for Complex Consumers Conference on 1-3 December. He will be a key speaker on the panel discussion discussing Complexity scales: Are they a useful tool for operational managers in transition care?

Walter de Ruyter comes to the aged care industry with background in health over the past 33 years. This has culminated in gaining experience across a range of vocational disciplines in nursing, midwifery and anaesthetics. The challenge is to provide services to ageing communities in a way that meets people's expectations. With the advent of consumer directed care these clients often do not see themselves as being old but just needing a hand to remain well and part of their community irrespective of where they live.


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