Community health services can enhance access to public and private health services by involving general practitioners and incorporating appropriate Medicare Benefits Schedule (MBS) services. The provision of services by private providers can complement the public services offered by community health. This approach makes publicly funded allied health services more available to the most disadvantaged groups.
Importantly, models adopted by community health should not result in a reduction of public allied health services.
Establishing MBS services may not be an appropriate option for all community health services and will depend upon a range of local factors including demand and available workforce.
How community health services select a service model
Community health services need to consider four key factors when developing a service model:
- Location - Will services be provided within the health service, or outside the health service?
- Provider recruitment - Are providers recruited from within the existing service staff, or will the service approach external providers?
- MBS revenue flow - Does the provider receive the MBS revenue (and then pay the community health service for rent, equipment, etc.) or does the provider donate the MBS revenue to the community health service (which then pays the provider)?
- Managing the provider and billing - Does the community health service manage the provider, and does the community health service manage billing processes (with both consumers and Medicare Australia)?
Service models currently used in Victoria
Victorian community health services use a range of service models to incorporate MBS-funded services, by either extending the hours of existing part-time staff or contracting with external private providers to provide services either on or off site, such as from a local general practice.
100 per cent donation model
A community health service contracts with a private provider to work for community health. The private provider attracts the MBS income, but donates 100 per cent of this income to the community health service and is remunerated by the community health service.
Percentage split model
Alternatively, private provider(s) may be paid through a percentage split of income arrangement. For example, the community health service takes a percentage of MBS income to cover billing and other administrative tasks.
Rooms for rent model
A community health service offers rooms for rent inside its premises to a provider working private sessions to offer MBS-funded services. The provider and the community health service negotiate an amount to cover rent and other costs such as administrative support and utilities. The provider attracts and keeps the MBS payment.
Linking people to externally provided MBS-funded services
The community health service may identify clients who would benefit from additional MBS services, and develops and implements local care pathways and referral protocols with private allied health practitioners and general practitioners for these clients.
Lessons from early adopters
In 2009, eight community health services trialled service models supported by the MBS. These trials sought to establish which service models were most likely to achieve positive outcomes, especially improving access to allied healthcare.
The trials found community health services improved access by offering additional MBS-funded service model improves access. MBS-funded care models were most appropriate for managing less complex conditions (for example, a person presenting with 1 or 2 health issues).
No particular model or service arrangement was better than another. Rather, success depended on developing a model that suited the service context, accounting for factors such as service demand and workforce availability. Successful services also:
- conducted pre-implementation work such as a feasibility assessment, needs analysis and plan for general practice engagement
- fostered support from key stakeholders, securing a 'champion' general practitioner and building relationships with general practice staff particularly practice nurses
- managed internal change, bycommunicating clearly with staff and people using the service, using best practice project management and encouraging an internal cultural shift to integrate public with private services
- developing systems, such as efficient referral and information-sharing systems, electronic billing facilities and clear file management protocols.