Baseline Analysis Report of the Sonic WellNet Integrated Care Program

Australians are living longer and more unhealthily than ever before – and as a result, our nation's chronic disease burden is increasing. However, chronic disease sufferers tend to receive fragmented care that is poorly coordinated and considerably less efficacious than it could be, and this problem is compounded for those experiencing multiple comorbidities. New strategies are required to reduce demand and strain on Australia's health care services, prevent and manage chronic disease, and the process, improve the quality of life of chronic disease patients. With this in mind, Sonic Clinical Services established the WellNet integrated Care Program in 2016. WellNet is built on the principles of Patient Centred Medical Home model: a model of primary care that places special focus on improving care coordination and on encouraging greater patient self-management for those with chronic disease. Sonic Clinical Service is evaluating the program in partnership with Western Sydney University and the Health Market Quality Program of the Capital Markets Cooperative Research Centre. The evaluation has two phases. Phase One seeks to examine changes in clinical outcomes, risk of hospitalisation, patient activation measures and other disease-specific risk assessments in the first twelve months of the program, whilst Phase Two is intended as a two-year follow up. Taken together it is hoped that the results of this study will help inform patients and providers as to the benefits of the PCMH model and the advantages of shared decision-making and coordination care more generally; it is also hoped that these findings will help policymakers understand the benefits and challenges associated with implementing medical homes more generally.