Provider Network Newsletter
July 2015
At GHS we pride ourselves on
the quality of the service we
deliver, and working with a
high standard of providers is
central to this.
In this quarterly update we focus on the important
role of Clinical Governance. The emphasis we place
on all health practitioners that treat ADF personnel—
along their entire pathway of care—to adhere to our
clinical frameworks is paramount to our service.
I thank all of our valued providers for complying
effectively with our benchmarks.
Many of you would have had interactions with the
GHS Central Appointment Team (CAT). Our frontline
people are supported by a highly skilled Clinical
Governance team which is always available to provide
clinical guidance and support. ADF personnel are a
unique group of Australian’s and their health needs
often require complex and innovative solutions.
I commend both you and the CAT for working
together to provide the best solutions that are
clinically appropriate and meet the specific needs
of the ADF.
As the team concludes the financial year we have
also featured some fast facts and interesting
numbers from the previous year. Providing seamless
access to quality healthcare to the 60 000+
permanent and 20 000+ reservist uniformed ADF
personnel has always been an exciting challenge
and is a service we are honored to manage. It is
impressive to see the large volumes the GHS
Provider Network collectively delivers around the
nation, and I look forward to seeing FY15 results.
Thank you for your ongoing support,
Justine Cain
GHS General Manager
Medibank
Introducing
Dr Andre Dreyer –
an integral member
of the GHS Clinical
Governance team
“I am part of the Clinical Governance team
and we are responsible for clinical oversight
and provide clinical leadership across
Garrison Health Services.
We adhere to the Medibank Clinical
Governance framework to ensure
transparency and consistency in delivering
safe, high quality clinical services to the
ADF. At the core of what we do is to ensure
the best possible care and clinical outcomes
for patients.
I work with the CAT to provide advice and
guidance on the more complex referrals and
credentialing requests. Together we facilitate
the choice of the most appropriate provider
for the specific needs of the ADF personnel.
Within Clinical Governance we also focus on
clinical incidents and complaints. We examine
such cases to identify opportunities for
improvement and to promote and maintain a
model of safety and quality within the health
care delivery system for the ADF. We believe
that this is the responsibility of everyone on
the team.”
As you are aware, being a part of the GHS Provider Network,
we encourage you to follow service guidelines that are managed
within the Medibank Clinical Governance frameworks. As well
as having extensive experience in your respective fields, you are
required to meet and maintain all insurance, registration and
accreditation. These various activities result in compliance to
deliver a quality health service.
GHS and the importance
of Clinical Governance How we maintain and improve the quality
of medical care
Behind the scenes, GHS services are underpinned by
clinical quality frameworks and processes to ensure best
practice healthcare delivery.
The framework details clinical obligations and standards, to
create accountability and compliance, resulting in risk mitigation
and consistent excellence in healthcare.
Key pillars include:
GHS actively monitors the health professionals delivering services
to ADF personnel. We regularly review the Australian Health
Practitioner Regulation Agency registration status of all service
providers to ensure your ongoing compliance.
Although all of our subcontractors and service providers are
expected to achieve and maintain clinical excellence, a strong
emphasis on the Complaints and Clinical Incident Management
(CCIM) process requires meticulous recording and examining of
all incidents. This careful monitoring enables the implementation
of improvements that support a robust system, in turn minimising
the risk of incidents and maximising the standard of care.
• Workforce preparedness.
• Quality services.
In FY14, substantiated clinical
incidents made up only 0.01% of all
services delivered.
• Risk management.
• Clinical effectiveness.
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Complementary to the clinical framework, GHS’ seven core
pillars of quality care guide all activities and encourage
advancement in service standards and outcomes:
1. Safety of healthcare.
2. Effectiveness of healthcare.
GHS has the expertise of a Senior Medical Officer on the floor
at the CAT to add a layer of clinical guidance and to support the
team in ensuring the appointments are booked with appropriate
providers. They also act as an escalation point to assist with
the management of clinically complex and/or sensitive cases.
A National Medical Director oversees the team as a further
proficiency and quality control.
These frameworks and processes ensure that ADF personnel
will have a high level of confidence that they are receiving care
from the most appropriate credentialed providers. We thank you
for your ongoing compliance to our standards and enabling us to
deliver the best service possible. Read more on the website.
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Some fast facts!
• 21 000+ providers have been
credentialed by GHS since contract
inception.
• The CAT managed 103 800+ referrals in FY14.
• 94% of all initial referrals are to the GHS
Provider Network.
• The average wait time for ADF personnel to see a
specialist decreased by 7% in FY14.
3. Appropriateness of care.
• ADFIT processed 153 000+ Medical Specialist and 127 600+
Allied Health invoices in FY14.
4. Consumer participation in healthcare.
• The GHS preferred Hospital network has recently grown to
over 260.
5. Access to service.
6. Efficiency of service provision.
7. Health informatics.
2 • GHS does not manage or influence the ADF budget or
health policies. The focus is on guaranteeing the best
access to healthcare providers and improving the value of
every healthcare dollar spent by the ADF and, ultimately,
by the Australian taxpayer.
ADF policy on Assisted Reproductive
Technologies (ART)
In assessing ADF personnel eligibility for ARTs at the
Commonwealth’s expense, the ADF is guided by the criteria
outlined by Medicare and the Medicare Benefits Schedule.
Importantly, only those services and medications covered by
Medicare and the Pharmaceutical Benefits Scheme will be
provided to ADF personnel at Commonwealth’s expense, and
ADF personnel will be required to fund non-Medicare rebatable
services or medications personally.
Did you know?
Image courtesy of Dept of Defence
ADF On-base Health Centre’s provide a suite
of primary health services
Many ADF bases are fully equipped to supply the following
primary healthcare services:
Please note this is a reminder of ADF policy, not a change
in entitlement. An ADF ART Fact Sheet is available on the
GHS website to further clarify ADF policy. It explains which items
are to be billed to GHS, and which items will be required to be
paid for personally by ADF personnel.
If you have any further questions please contact the following
ADF contact points.
For queries related to:
• General Practitioner
• Dental
Entitlement: JHC-GHO.Approvals@defence.gov.au
• Pharmacy
• Mental Health
Invoicing: garrison.offbase@medibank.com.au
• Physiotherapy
The On-base health practitioners are solely dedicated to ensuring
the ongoing health of ADF personnel, and as such it is always
preferable for them to be managed in the appropriate ADF
environment.
Image courtesy of I-MED
If you treat an ADF patient that requires a referral for these
services they should return to the On-base Health Centre for
treatment (or further approval to see an Off-base service provider
where On-base treatment is not available).
If you provide a prescription or recommend a health related aid
or appliance, your patient should be referred back to the On-base
Health Centre with the prescription or recommendation for it to
be dispensed and/or approved.
Reminder
Aim to use the GHS imaging, radiology
and pathology referral partners
You can utilise the ADF Ward at St Lukes Hospital
in Central Sydney
In 2013 the Department of Defence contracted Medibank Health
Solutions (MHS) to provide a fully provisioned and operational
low acuity inpatient ward for exclusive use of ADF personnel at
St Luke’s Private Hospital, Potts Point Sydney.
The ADF Ward includes 12 dedicated beds, each in a private
room with ensuite facilities, a dedicated recreation area, along
with an onsite ADF Liaison Unit that provides full administration
and discharge support. There is a senior ADF Medical Officer to
service the Unit.
The dedicated ADF Ward at St Luke’s Hospital is the contracted
solution for an ADF inpatient in the Central Sydney region and it is
preferable, where clinically appropriate, that ADF personnel are
admitted here for surgical procedures as well as general medical
conditions.
The ADF Ward is also suitable for ADF personnel that require
post-surgical recovery, in the instance that discharge to the Base
is not an appropriate option.
3 GHS provides ADF personnel with access to nationwide
diagnostic expertise, supported by state-of-theart technology to identify, treat and monitor illness
and disease.
Please be reminded to utilise the quality providers
we have subcontracted for your diagnostic needs to
ensure ADF personnel have access to a consistent
nationwide experience.
I-MED: for imaging and radiology services. For clinic
locations please refer to the state guide on the website.
Special Diagnostic Services (SDS): for pathology services.
For collection centres please refer to the state guide found
in the website.
70 000+
Imaging and radiology procedures
performed by I-MED in FY14
270 000+
Pathology items delivered by SDS
in FY14
Working with us – a checklist
Send all invoices direct to GHS via:
Emailgarrison.offbase@medibank.com.au
Fax
1300 633 227
MailGarrison Health Services
C/- Medibank Health Solutions
PO Box 9999
Melbourne VIC 3001
• ADF personnel
The Health Hotline
• Referring ADF On-base Health Centres.
Supporting the ADF after hours
Send written health reports back to the
referring ADF On-base Medical Practitioner:
Medibank is Australia’s largest provider of telehealth
solutions, enabling GHS to offer the Health Hotline, a
customised national telephone-based triage service to all
ADF personnel.
• Within five business days.
• Details are located on the PM528
referral form.
• Do not send written health reports to GHS.
Seek approval for non-approved services
from the referring ADF On-base Medical
Practitioner for:
• Treatment that does not attract a rebate
under the Medical Benefits Schedule
or is not listed on the Pharmaceutical
Benefits Scheme.
• Where there is a requirement to recommend
a course of management that goes beyond
the scope of what was requested on the
initial referral.
• If an elective procedure or treatment is
recommended that is likely to require the
ADF personnel to be unfit for work for more
than one day (the scheduling of which may
require negotiation with the personnel’s Unit
Command).
• Any Health Appliance, Physiotherapy and
Rehabilitation items or equipment.
• Plastic surgery generally requires preapproval, which will only be considered in
the context of a clear clinical indication or
reconstruction following injury.
Do not seek clinical approval for non-approved
services from GHS.
medibankhealth.com.au/garrisonhealthservices
In unexpected times of need, the Health Hotline gives a 24/7
layer of assistance—providing triage, health information and
provider referrals. Further to afterhours support, the Health
Hotline plays an important role when ADF bases are closed
or operating at a reduced capacity. In fact, in FY14 20% of
callers required immediate medical attention.
Do you have a colleague
who could support the ADF
and the vital role they play
for Australia?
By the nature of their profession, ADF personnel need
to maintain operational readiness or regain peak health
condition to fulfil their duties—it’s crucial they have
access to world-class healthcare.
Refer a qualified healthcare provider, and encourage them
to use their medical expertise to support this interesting,
important and unique group of Australians. If they apply
to the GHS preferred provider network your colleague
could benefit from priority status in referral systems and
favourable payments terms, while taking pride in playing
the essential role of serving the health needs of Australia’s
Defence Force.
For more information
Call: 1300 126 420
Email: adfenquiries@medibank.com.au
Visit: medibankhealth.com.au/
garrisonhealthservices
127028687_0715
Do not send invoices to: