No Gap Joints Short Stay Treatment
BACKGROUND Australias private health Insurance industry is in decline, industry stakeholders collaborate in the design and implementation of services to ensure members enjoy timley access to safe, high quality services, limit member out of pocket charges to bolster the value proposition of private healthcare and ensure health insurance remians affordable to encourage participation. HCF, Australias largest not for profit insurer has partnerned with hospitals, surgeons and clinicians in the design and implementation of Joint Member Value Initiatives including the ‘ HCF No Gap Joints Program’ (HCF Program) to deliver an enhanced experience to members requiring surgery to replace hip and knee joints. HCF contributes the funds and manages the contractual arrangements with hospitals and surgeons participating in the Program.
Total Hip and Total Knee Replacements are expected to increase by 208% and 276% respectively and costs to the private healthcare sector are forecast to exceed $3.54 billion. Ackerman et al. BMC Musculoskeletal Disorders (2019).
Due to the ageing population, Australia is facing an unsustainable joint replacement burden.
AIM: The HCF Program aims to achieve the following three objectives;
- Access to evidence-based perioperative management/care programs, either admitted (overnight/day), or rehabilitation at home according to patient needs.
- Test the appropraiteness of a short stay treatment model (from a patient outcome and safety perspective), and clinical outcomes vs a traditional long stay model of care for joint replacement surgery.
- Eliminate unexpected member out of pocket charges.
RELEVENANCE OF INITIATIVE:
Surgeon led models of care that improve clinical outcomes are imperative to the sustainbility of the private health care system. Short stay models of care trialing in the Australian health care setting are well establshed in Europe and America, trials such as the HCF Program will assist the adoption and test the appropriateness of a broader implementation of the short stay model across private and public health care settings.
PATIENT DESCRIPTION AND INVOLVEMENT:
Patients requiring total unlitaral, total, hip and knee joint replacements.
Surgeons involve the patients requiring surgery in the decision making process required to undergo joint replacement surgery.
The HCF Programs are established through a process of consulation with hospital executive, surgeons and aneasthetist to agree on the conditions required to secure a no gap member experience.
Participating surgeons are responsible for desiging the patient selection criteria and selecting patients suitable for the short stay program. Patients must be a HCF member, meet the eligibilty and patient selection criteria required to undergo a primary hip or knee replacement.
SIZE & SCOPE:
More than 100,000 joint replacement surgeries are undertaken each year in Australia.
The scope of the No Gap Joints Program is limited to the services required to conduct total hip and knee replacement surgeries including diagnostics, aneasthetists, support and rehabilitaion services, hospital theatre and accomodation.
The HCF Programs are in pilot phase, early results indicate an improvement in patient outcomes related to reduced pain and improved quality of life, reduced length of stay in the hospital and reduced costs to the member undergoing joint replacement surgery.
HCF has established strategic partnerships with select hospitals, surgeons, anaesthetistis and clinicians to collaborate in the design, implementation and evalution of the No Gap Joints Program.