Medicare’s Chronic Disease Management
Written by Sean Cooney
With the chronic disease management and team care arrangements offering such a wide scope of practice for a wide variety of people, no two patients are really the same. But, of course, there are some key similarities.
Patients who see multiple allied health professionals on one referral
When the five sessions are spread across 2-3 practitioners we find that the first practitioners’ initial assessment is really important. The GP referral is so valuable at providing the history of the presenting illness or ailment and the goal setting section is instrumental. Where the patient decides to start the allied health care approach, ie which practitioner they see first, normally dictates the approach that they want to take.
For example, seeing a physio before the AEP may mean that there could be a level of fear avoidance behaviours that are present due to the length or severity (or both) of the patient’s condition. Seeing the AEP before the physio may mean that they’re more keen to get started with exercise and wanting to top up on education around their previous injury or refresh their self management strategies. Seeing the dietitian before an AEP or the physio may mean that they know that their food choices are impacting their ability or willingness to move. It can also mean that this is what they’ve identified as the best place to start forming better habits or routines around a healthy living – considering that we can eat 3-5 times per day whereas we might only exercise once.
5 sessions or more?
The premise of the CDM program being about setting goals and then setting a plan to achieve these goals means that we need to have an early conversation around how much they’re expecting to achieve in the 12 months that the sessions are valid. Some like to use their sessions and move straight onto the private healthfunds but for others they can only afford the 5 or only want the 5 sessions. When the person is requesting to continue beyond the 5 sessions, these initial sessions serve really well to get a thorough assessment of where the patient’s condition is at, how they have been managing, educate them on updates to evidenced based practice that are applicable to their condition and then getting started with a meaningful intervention. When the person is only wanting the 5 sessions from Medicare it is much more about educating on self management strategies and tools for reassessment from day 1. Patient’s can feel they didn’t get value out of the sessions if they’ve started on a plan of intervention that there wasn’t adequate follow up to reassess whether this was effective for them or not.
The value in a health spend
Working in CBD areas in North Sydney and Broadway, sometimes the reliance on a Medicare subsidy isn’t so great which can bring into question one’s value on the contribution. I think it stills gives the opportunity to set the person up for success and moving towards a happier and healthier existence. The premise of the management plan, to have the GP integrating with allied health professionals, mandating that we communicate, including the use of objective measures, health care plan and goal setting with time frames is no doubt the structure that is required to deliver long term outcomes and reduce the “burden of disease”. If this gives a person the first taste of this approach, it can surely do no harm. Whichever is the patient preferred approach to their healthcare, the program is awesome and can be so effective. We’re truly lucky to live in Australia. As long as expectations are clearly communicated and smart planning is discussed from the initial appointment then we can truly chip away year on year, helping the patient adopt good management strategies to manage their chronic conditions.