8. Engaging payers, providers, clinicians and consumers

Working along the health care value chain is important for integrating care. Positioning changes in the context of current and near-term problems, and aligning with current and planned solutions can be effective in stakeholder engagement. For example:

  1. Engaging payers – describing how expenditure can be reallocated from fast growing areas (for example chronic disease items under Medicare, joint replacement surgery billable to insurers or planned growth in hospital capacity such as dialysis wards) to more cost effective areas (such as patient education in chronic disease, physiotherapy and pain management of joint disease, and in home dialysis units). Building on current reforms such as Medicare and PHI (private health insurance) reviews, healthcare homes, digital health records and generic medication pricing, will help build a bridge to funding and supporting new integrated initiatives.
  2. Engaging providers – for private hospitals, it is helpful to understand desired case mix (e.g. elective surgery over complicated, unplanned medical admissions) and identify benefits such as relief from elderly, 30-day readmissions. For public hospitals, positioning out of hospital integration efforts can gain traction if there is direct linkage to improvements in 4 hour access targets, Ambulance bypass pressures, low acuity emergency presentations (e.g. ambulatory cases) and early discharge opportunities.
  3. Engaging clinicians – understanding the different types of clinicians and their perspectives is important. Some respond to economic incentives (e.g. pay for performance), whilst others care more about improving patient outcomes or experience, reducing waste and saving time, or career advancement and professional development. Some clinicians are tech savy whilst many aren’t, some embrace teamwork whilst others are protective about their patients being poached by other craft groups, and some prefer face-to-face engagement whilst others like to engage via email, phone or letters.
  4. Engaging consumers – patient activation is important in achieving health outcomes; whilst health systems can be more ‘integrated’, it is up to consumers to engage, experience, and follow-through with health care services and advice. Estimates are that patient compliance with medications, appointments and care plans can be as low as 50 percent. Motivational interviewing, health coaching, patient mentorship and providing fun activities (e.g. group activities, gamification, learning events) are helpful to building patient rapport. Providing more consumer friendly and patient-centric services are also key (e.g. comfortable medical centres, doing home visits, helping after-hours and ensuring a customer service culture).