What we do

My Care Partners for patients with complex conditions

My Care Partners is an innovative new program for general practices in South Western Sydney. Eligible general practices joining My Care Partners become part of a medical neighbourhood, providing enhanced care to patients with chronic and complex conditions who are at risk of frequent hospitalisations.

 

Definition of Medical Neighbourhood – NSW Agency for Clinical Innovation

 

My Care Partners objectives

  • Improve coordination between the patients’ medical home (their regular general practice), primary and community services, and acute care.

  • Improve outcomes for patients with complex and chronic conditions who are at risk of potentially preventable hospitalisations.

  • Improve patient and provider experience by encouraging continuity of care and team-based care to reduce the risk of omission or duplication of services.

 My Care Partners was co-designed by South Western Sydney PHN (SWSPHN), South Western Sydney Local Area Health District (SWSLHD) and members of the community.

 

My Care Partners is an ongoing program. The vision is for My Care Partners to expand geographically within South Western Sydney, as well as expanding across different patient cohorts within each My Care Partners practice. 

 

Benefits for your practice

My Care Partners practices will receive ongoing support to transform into a Patient Centred Medical Home (PCMH). 

Practices will be supported to complete models of improvement to improve key areas within the PCMH model; patient centred care, coordinated care, comprehensive care, accessible care and safe, high-quality care. 

Practices receive ongoing support from SWSPHN to implement My Care Partners into their workflow processes. 

 

Support for My Care Partners practices to become a Patient Centred Medical Home

My Care Partners practices will be supported to become a Patient Centred Medical Home (PCMH) through access to:

  • Ongoing support from the My Care Partners team and SWSLHD Care Enabler team to improve outcomes for patients living with complex chronic conditions
  • Training in digital health readiness and enrolment readiness from the SWSPHN team and Care Enabler team
  • Free workshop attendance
  • Access to ‘shared cost savings’ distributed across the ‘medical neighbourhood’ for practices who achieve patient outcomes
  • Payments to the practice for setting up as a My Care Partners practice, and ongoing patient enrolment and activity payments
  • Opportunities to network with other My Care Partners practices and external providers in your ‘neighbourhood’ to improve communication and enhance relationships

To find out more about My Care Partners call 02 4625 3000 or email [email protected]

My Care Partners practice enquiry

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