HealthPathways: An economic analysis of the impact of primary care pathways in Mackay, Queensland

HealthPathways overview: HealthPathways is a clinical pathway portal that enables general practitioners (GPs) to better manage their patients in the primary sector. Pathways for various diseases assist GPs with patient assessment, management, referrals, and best practices tailored to the local context to provide more comprehensive care. AusHSI was contracted to conduct an economic analysis of HealthPathways for four disease groups: cardiology, diabetes, urology, and respiratory conditions. In this paper we sought to analyse the impact of Mackay HealthPathways on patients, providers, and the health system through economic analysis. HealthPathways is designed to improve referral appropriateness, improve GP confidence in managing complex conditions, and reduce unnecessary care. The program is intended to ensure the right care, at the right time, in the right place and delivered to the right person. Analysis and results: The data included in the analysis were aggregate PenCAT figures across Mackay region, primary care referrals, and all acute and specialist outpatient utilisation from January to March in 2015 and 2017. Diabetes was chosen as the intervention group as it featured comprehensive HealthPathways implementation. Urology was not supported by HealthPathways as of March 2017 and represents the control group. Cardiology and respiratory conditions represent partially implemented HealthPathways conditions. While statistically rigorous conclusions were not possible, we showed that the diabetes pathways improved referral appropriateness by 27%, while the urology control group experienced a 15% rise in inappropriate referrals. There was no decline in health outcomes and no increase in hospital costs from avoiding these referrals. Implications for Mackay and Queensland: While more research is required to show cost-effectiveness and outcomes for patient health, the Mackay Health system could potentially save hundreds of thousands of dollars in avoided unnecessary referrals per Pathway. If HealthPathways is fully integrated across Queensland for every chronic disease requiring referrals, the program could generate even greater cost savings. We believe there is sufficient evidence to continue the HealthPathways program while collecting comprehensive data to determine the health and economic impacts. Recommendations: AusHSI recommends the continuation of HealthPathways provided that the program is fully implemented as per the diabetes clinical pathway. This includes a developed suite of clinical and referral pathways, however the diabetes pathway’s success was likely due in part to the requirement for GPs to consult HealthPathways before making referrals. This is a critical component that should be expanded to other available pathways. AusHSI also recommends that a comprehensive HealthPathways evaluation be conducted using patient-level data to identify whether HealthPathways can be a cost-effective program across the state of Queensland.