Medibank moves into GP care to push ‘quality’ deals

AUSTRALIA’S largest health fund, Medibank Private, has extended the level of protection and support it provides to members.

AUSTRALIA’S largest health fund, the government-owned Medibank Private, has extended its level of protection and support for members, declaring better quality care the key to making the system financially sustainable.

Despite the Abbott government wanting the private sector to play a greater role, Health Minister Peter Dutton has ruled out inviting insurers to take part in negotiations with the Australian Medical Association and senators over the plan for a $7 co-payment.

Medibank Private, which is to be sold, has followed the lead of Bupa and signed a quality-based funding agreement with a hospital network, Healthe Care, imposing financial disincentives for unplanned readmissions and adverse events. It plans to negotiate similar deals with the larger networks.

This means it is effectively closing the loop for members, trialling a no-charge GP and after-hours service in an attempt to keep members healthier for longer, while building its health-services arm. If members require more acute, and costly, hospital care, the fund wants to limit any setbacks and intends to expand a pilot program to better co-ordinate post-discharge care, reconnecting members with GPs and providing telehealth support as required.

“We’ve made a very clear decision to move from being a passive payer to being an active payer, and monitoring and ensuring positive outcomes is really at the centre of this,’’ said Andrew Wilson, the fund’s executive general manager of provider networks and inte­grated care.

“Our focus has to be around quality outcomes — that’s what’s going to create more sustainability in our health system.”

Dr Wilson said the move into primary care was a key part of that strategy as GPs were best placed to drive preventive health and hold off chronic and lifestyle-related diseases.

The commission of audit recommended an even greater role for insurers, wanting the government to compel high-income earners to take insurance and use it for everything from GP visits to public hospital services, but Mr Dutton ruled out further legislative change.

After meeting the AMA on Thursday night, Mr Dutton said he would consider its proposed redesign of the co-payment while continuing talks, but said “private health funds aren’t part of these discussions and negotiations”.

Mr Dutton again refused to be drawn on what the government might be prepared to alter and re­iterated there were broader budget considerations. The point of the negotiations was “all about seeing the safe passage of the $7 co-­payment through the Senate”.

The government wants to cut standard Medicare rebates by $5, notionally using the savings to establish a $20 billion medical research fund, and give an incentive for doctors to charge patients $7 to cover the loss — with a small profit to help bulk-bill certain patients.