There are three compelling reasons why AICCHSs have seen the benefits of establishing CQ RAICCHO.
1. Regional Scale attracts Resources
QAIHC and its member AICCHSs realized that resource allocation for Aboriginal and Torres Strait Islander primary health care changed to a regional focus for planning, coordination and resource allocation with the establishment of regionally-based Medicare Locals by the Australian Government, and Queensland’s own Hospital and Health Services with their own Boards. From the Australian, funding growth came via Medicare Locals, not just for enhanced primary health care but also for aged care and mental health. Divisions of General Practice were amalgamated into large regions to provide the core organizational infrastructure for Medicare Locals.
Under the Productivity Commission’s reforms for the aged care sector, service delivery devolves to “regional centres” of the proposed National Seniors Gateway Agency, based on Medicare Local regional boundaries. If AICCHSs want to be part of these reforms for the elderly in their communities, they need a regional approach. The Institute for Urban Indigenous Health Ltd (IUIH) has already gone down this road for South-East Queensland, developing a region-wide “Master Plan 2013/2017” for Indigenous aged care services in SEQ, highlighting serious service gaps north of the Brisbane River. IUIH developed a professional application for Aboriginal and Torres Strait Islander “Home Care Packages under the 2013 Aged Care Approvals Round. 52 Consumer Directed Care-Home Care Packages are currently being managed by IUIH under an integrated approach that links aged care services with primary health care services from the Morayfield, Deception Bay and Strathpine Clinics – the first time a RAICCHO has been able to provide integrated aged care and primary health care services in Queensland. The implications for CQ RAICCHO were clear.
Central Queensland is fortunate in that the Wide Bay Medicare Local is headed by the chief executive officer of the GP Links Wide Bay Division of General Practice, who has consistently evidenced his strong support for the Medicare Local to take Closing the Gap seriously and is a supporter of Aboriginal community control of primary health care. By setting up CQ RAICCHO, AICCHSs were doing the sensible strategic thing to position themselves for access to government Indigenous health funding into the future, coming through Medicare Locals and through Queensland’s own Hospital and Health Services (HSSs). CQ RAICCO can provide all the Member Organisations with the capability to undertake region-wide data analysis, mapping, and gap analysis planning; without CQ RAICCHO, fragmented and isolated AICCHSs would not project the planning, management and service delivery capabilities to secure enhanced funding.
2. Growth as well as Sustainability
A regional organization provides two opportunities for its constituent AICCHSs. The first is its contribution to sustainability. The second is its contribution to growth.
The days when AICCHSs could rely on government grants for business operations have long gone. For about 12 years, the Australian Government through its Department of Health and Ageing (DoHA), now the Department of Health (DoH), made it clear that their policy was to have no more Aboriginal Medical Service start-ups. The four-year funding through COAG of the Indigenous Health National Partnership Agreement concluded in June 2013, and no one can say how much of the funds will be continued by the Australian Government because a Commission of Audit Commission will recommend expenditure cuts, that will target ‘Health”. The LNP State Government in Queensland has embarked on a significant expenditure reduction strategy, and although the State Government does not provide core funding to AICHSs, it does provide many AICCHSs with program-specific funds.
The message is clear: AICCHSs need to demonstrate the efforts they are making to sustainability through a balance of self-financing and government grants.
But just ‘marking time’ at the existing performance levels means AICCHSs are not contributing to Closing the Gap in Aboriginal life expectancy within one generation. AICCHSs have to grow, to expand client services and population health/preventative programs.
By creating the IUIH Ltd, the four founding AICCHSs in South-East Queensland have been able to bring in more than $15 million of new health investments that diversify the range of programs that Aboriginal people can engage with to improve their health outcomes, and to open up brand new Clinics in locations where Aboriginal people have moved to, away from the historical sites where AICCHSs were set up a long time ago.
The challenge for CQ RAICCHO is to emulate the IUIH and expand services and access.
3. Improving Productivity, Expanding Access
The IUIH in SEQ has demonstrated that the key to improving productivity of primary health care services is an effective Model of Care linked to an efficient Business Approach. Individual AICCHSs find it difficult to install change management programs, for all sorts of reasons. The Institute has demonstrated that a Clinic with one GP plus two Registered Nurses, a Practice Manager, two Medical Receptionists, an Aboriginal Health Worker, a Driver and a Community Liaison Officer can generate up to $0.8M per annum through building on a clear community engagement strategy and using common-sense patient cycle of care systems and procedures involving MBS 715 Health Checks, GP Management Plans, Team Care Arrangements, GPMP and TCA reviews and follow-ups, and other MBS-eligible services.
This level of productivity is needed in Central Queensland and CQ RAICCHO has the capacity to successfully install this Model of Care into the clinics of its Member Organisations.
One of the keys to improving productivity in AICCHSs is to professionalise clinic operations by having competent Practice Managers who treat each Clinic as its own cost/profit centre. Targets are set in terms of client numbers, including numbers of chronic disease clients, and in terms of MBS claims billed, down to specific MBS Items. Performance is tightly monitored on a daily and a weekly basis. The introduction of CQ RAICCHO enables the Member AICCHSs to re-shape and plan the expansion of the scope of their Services.
CQ RAICCHO will also be in a position to negotiate access by the Member AICCHSs to a range of medical, nursing, dental, and allied health professionals.
CQ RAICCHO will also introduce a regional system of shared electronic client health records amongst the four Member Organisations; again, experience in SEQ has shown that only the leadership by a regional entity such as CQ RAICCHO can achieve this outcome which greatly improves the quality of the patient journey and positions the AICCHSs for better integration of client services with the State Government hospital system.