Health Care Homes: Can practices help to address the social determinants of their patients’ chronic ill health, and if so, what thinking and planning is required now?
The Health Care Homes model is a new funding arrangement for general practices to coordinate care for people with chronic and complex conditions. Patients will be able to voluntarily enrol. The model is about to be trialed in 200 general practices, and it is expected that more practices will be able to participate from 2018 onwards.
The social determinants of health refers to the social conditions (physical and social environments) in which people are born, live and work. A bold statement: if health care homes are to make significant improvements in the health of high risk patients with chronic disease, they must consider how to help address their patients’ social determinants of health.
* the social conditions in which people are born, live and work is the single most important determinant of good health or ill health (World Health Organisation, 2013)
* 20% of Australians living in the lowest socioeconomic areas in 2014-14 were 1.6 times as likely as the highest 20% to have at least two chronic health conditions (ABS, 2015)
* for people in poorer households, the chronic stress associated with the scramble to ‘make ends meet’ each week can lead to new or exacerbated mental health issues, decreased energy and motivation, the harmful use of ‘coping’ substances including alcohol, tobacco and other drugs, and more consumption of unhealthy food (Hill et al, 2013)
*people in low economic resource households spend proportionally less on medical and health care than other households (ABS, 2012).
Based on our experience helping general practice clients to apply for PHN funding and prepare for new (commissioned) models of care, we believe the biggest challenge for practices – and the greatest opportunity – will be in embracing challenges that come with the fact that successful Health Care Home models are not ‘business as usual’ and in embracing a clear plan for readiness.
Though addressing the social determinants of ill health are, by definition, outside the realm of usual medical care, this presentation will consider how practices may be able to do so and what knowledge, skills, HR configurations, training, partnerships and support will be needed.