The CBG report identified general support for the concept of Care Plus amongst most practices (GPS and nurses), PHOs and DHBs, that is, as a programme for targeting patients with high needs and chronic conditions. Eighty percent of PHOs were delivering Care Plus in some or all of their practices by April 2006.
While enrolment growth has been slower than expected, Care Plus appears to be reaching patients with chronic high need, particularly those with diabetes and cardiovascular disease. Most of the patients surveyed felt their care had improved under Care Plus, and in particular that it was more structured.
The evaluation did identify some areas for improvement. For example, in its current form, Care Plus may not be well suited to patients who need intensive interventions requiring multiple health care contacts over a short period of time such as those with mental health needs and the terminally ill. The evaluation found little evidence to suggest the Care Plus model should be significantly altered in terms of the objectives of the programme, although the reviewers suggest that Care Plus may need to be enhanced to better facilitate care planning and to increase primary health care teamwork.
The Ministry of Health and DHBs will, via the Primary Health Care Strategy Implementation Joint Work Programme, explore a range of options for addressing the issues and recommendations raised in the CBG evaluation.
Key Results
2006.- Significant resources are needed for setting up Care Plus to identify patients who may be eligible for the service and to establish clinical and business processes for delivering Care Plus, both within a practice and at the PHO level.
- Even in practices that have been delivering Care Plus for some time, enrolment growth has been much slower than expected. By April 2006 only 39 percent (range 3−122 percent) of predicted eligible5 patients were enrolled in PHOs that had started Care Plus.
- Funding models employed by PHOs vary widely. All PHOs receive funding according to the national agreement, but there are variations in the extent of the initial practice payment and how the per visit reimbursement is distributed to the member practices.
- Although PHOs receive 50 percent up-front funding, ongoing PHO income is dependent on adequate enrolments and HealthPac accepting practice claims.
- Patient co-payments cited by practices surveyed ranged from 0 to $42 (242 randomly selected practices). The mean was $6.61, and the median was zero. Eight percent of practices charged more than $30 for a Care Plus visit. Patient co-payments ranged from 0 to $20 in the patient survey (300 patients from 30 practices).
- Care Plus services are equally likely to be delivered by doctors and nurses, either solely or in combination. Eighty-seven percent of practices give patients a Care Plan. Two-thirds of practices surveyed run Care Plus in conjunction with a CCM programme.