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Building successful
 Referral Networks



            WORKING FOR A FITTER, HEALTHIER AUSTRALIA
Agenda
Introduction – recent history
Why a focus on referral networks
Fitness a valuable player in Health landscape
Current state of referral opportunities for Fitness
Submission for Evidence based strategies
Feedback from Health sector and practical
application
                                  WORKING FOR A FITTER, HEALTHIER AUSTRALIA
Recent history of Fitness on Health map


2010 – Government funding for Healthy
Communities initiatives.
Saw roll out of funding for the Lift for Life program
2011 – Introduction to the Adult Pre-exercise
Screening System (APSS)
2012 – Further opportunities for integration into
Health Networks

                                  WORKING FOR A FITTER, HEALTHIER AUSTRALIA
Recent history of Fitness on Health map


Fitness industry has not traditionally engaged effectively with
health and medical services.

No uniform method for engagement.

Beginning with standardised screening process is a positive
step.

Clear absence of a systematic, effective approach to referral.




                                         WORKING FOR A FITTER, HEALTHIER AUSTRALIA
Recent history…

Locally, Active Script and Lifescript programs - government funded initiatives
 Focused on capacity building and awareness-raising amidst GPs


The Green Prescription program in New Zealand
 Focused upon GP engagement and referral to activity providers


The General Practice Exercise Referral Scheme undertaken by the Sutherland
   Division of General Practice and the Sutherland Shire Council (NSW)
 Focused on referring individuals to facility based programs and activities




                                                WORKING FOR A FITTER, HEALTHIER AUSTRALIA
Recent history…
Government funded initiatives and research have collectively led to improved
  knowledge and understanding of what can work and why.
For example, we now know:
 85% of the pop visits a GP at least once per year

 the average person makes 5.4 visits per year (2008/09)

 60% of patients were 45+ years, 80% of them with a chronic condition

 GPs believed to have the most significant influence on lifestyle decisions

 behaviour can be significantly affected through brief consultations with GPs

 GPs are first point of contact for a referral, with 13% of all visits including a
  referral – 28% of these to allied health (Physio, Psych, Pods, Diet, etc.)



                                                  WORKING FOR A FITTER, HEALTHIER AUSTRALIA
Recent history…
Research has also helped to identify the features of a successful referral
   model.
These include:
 Strong relations between providers and GPs
 GP knowledge around physical activity and exercise
 Having a central point for referral, having an enabler/ coordinator role
 Electronic and hard copy support resources
 A clear definition of duty of care for GPs and exercise providers
 Provision for specific populations
 Training and quality assurance of providers
 Good access to affordable local programs and providers


                                                WORKING FOR A FITTER, HEALTHIER AUSTRALIA
Recent history…
A number of detailed resources that contribute to an informed
   understanding of Exercise Referral have been developed
   for GPs in Australia:



The RACGP’s red book and green book provide an outline of
   evidence and process for GP referral to preventative
   activities such as physical activity.



The RACGP SNAP population health guide to behavioural risk
   factors in General Practice is another resource that
   provides guidance.


                                                WORKING FOR A FITTER, HEALTHIER AUSTRALIA
Recent history…
It is evident that considerable investment and effort has been made to better
     understand and progress the development of exercise referral in the past,




HAVE YOU EXPERIENCED THE BENEFIT OF THIS??



A clear need for a sustainable broad-based method for referral between health
   and exercise services still remains.




                                               WORKING FOR A FITTER, HEALTHIER AUSTRALIA
Fitness Industry Association Initiative


Recent funding submission to the Department of Health and Ageing:
Develop and test a multi-disciplinary exercise referral system within the new
Medicare Locals (primary care health network setting).
Several other stakeholder organisations have supported the submission.
1. Evidence collection of existing schemes
2. Consultation process with relevant associations
     RACGP
     SMA
     APA
     DA
     ESSA
3. Pilot – focus on Medicare locals

                                               WORKING FOR A FITTER, HEALTHIER AUSTRALIA
Why focus on referral networks


Changing face of population health – are we adapting?


Desire from medical and allied health sectors – but also barriers.




                                      WORKING FOR A FITTER, HEALTHIER AUSTRALIA
Fitness in Health landscape
Changing face of population health – are we adapting?




                                          WORKING FOR A FITTER, HEALTHIER AUSTRALIA
Fitness in Health landscape
Changing face of population health – are we adapting?




                                          WORKING FOR A FITTER, HEALTHIER AUSTRALIA
Fitness in Health landscape
Changing face of population health – are we adapting?




                                          WORKING FOR A FITTER, HEALTHIER AUSTRALIA
Current state of referral opportunities for
                       Fitness Industry


Barriers?
Awareness of service providers
Awareness of quality
Fears over liability
Lack organised referral system




                                   WORKING FOR A FITTER, HEALTHIER AUSTRALIA
Current state of referral opportunities for
                    Fitness Industry


the positive, negative, positive sandwich…

Positive: You are passionate and enthusiastic about health and
fitness

Negative: Your approach and business process is not structured and
measurable

Positive: You are an inspirational person who can motivate people to
change



                                         WORKING FOR A FITTER, HEALTHIER AUSTRALIA
Barriers to referrals

Fears over liability
Recent ‘Australian Doctor’ Journal article:
Mounting requests for 'fit to exercise' certificates have led to accusations
gyms are shifting liability onto doctors for training-related mishaps.

"The problem is you don't know what the exercise program is, you don't know
how experienced the person writing the program is, and you don't know if the
patient has some underlying problem”

“the lack of consistency between fit-to-exercise forms was a concern, with
certificates often vague or open-ended.”




                                                       WORKING FOR A FITTER, HEALTHIER AUSTRALIA
Practical application and tips

 Standardised screening and
  referral tool

 Clearance vs guidance
  language

 Re-assessment tool of
  modifiable risk factors (Stages 2
  and 3)

 Focus on follow through on
  information collected



Webinar 17th May 11am-12pm
                                      WORKING FOR A FITTER, HEALTHIER AUSTRALIA
Practical application and tips
 Positive and professional first impression for
  client and medical or allied health professional
 Demonstrates commitment to evidence-based
  industry standards, nationally recognised
  procedures and legal obligations – as per
  other professionals in health sector
 Helps to build client and professional
  trust, rapport and communication
 Guide to defining scope of practice - operating
  outside of scope is a common reason for
  conflict with other professions
 Demonstrates commitment to a client-centred
  approach


                                                WORKING FOR A FITTER, HEALTHIER AUSTRALIA
WORKING FOR A FITTER, HEALTHIER AUSTRALIA
Medicare Locals


Replacement for Divisions of General Practice

Primary health care organisations

Established to tackle local health care needs and service gaps

Opportunities for education and networking

www.yourhealth.gov.au




                                             WORKING FOR A FITTER, HEALTHIER AUSTRALIA
Practical application and tips


Allied Health Professional (AHPs –
Physio, Pod, Chiro, Diet, Psych, etc.)



They WANT to hear from you

They look for further support for their patients

If in private business they NEED referrals from you!!




                                                   WORKING FOR A FITTER, HEALTHIER AUSTRALIA
Practical application and tips

Allied Health Professional (AHPs – Physio, Pod, Chiro, Diet, etc.)

 Have a working relationship established (ideally prior to the initial referral
  being made).

 Sound working knowledge of how the professional works, from the basic
  practicalities such as:
         Costs
         Opening hours
         Locations

 Individual knowledge base (particular strengths and weakness)

 What particular client groups they enjoy working with.

Ensure client is well prepared for referral experience!
                                                WORKING FOR A FITTER, HEALTHIER AUSTRALIA
Practical application and tips


Allied Health Professional

 Ideally involves meeting face to face to establish
  these things

 Observe each other in practice



“I encourage the fitness professional to visit our clinic to see first hand the
way we manage clients from the initial phone call to the assessment and
ongoing treatment process. A complete understanding of these things
enables the referral to be set up for success from the outset and trust in the
person being referred to.”

                                                 WORKING FOR A FITTER, HEALTHIER AUSTRALIA
Practical application and tips

Allied Health Professional (AHPs – Physio, Pod, Chiro, Diet, etc.)

 Gain written, informed consent to communicate from the client

 When referring, communicate (via phone, email, letter or fax prior to the
  client arriving for their assessment) about:

          The reason for the referral

          and what they and the client want to get from AHP.

 Expectation for regular progress reports, specifically about identified goals
  (Short and objective)

 Prompt reply to communication when appropriate (within 24 hours/business
  day)


                                               WORKING FOR A FITTER, HEALTHIER AUSTRALIA
Practical application and tips

Allied Health Professional

 Client must have a good understanding of why the referral process is
  necessary

 Client should be informed of practical things like the
  location, costs, appointment times, waiting times;

     what to expect within the assessment and treatment process

     and why the referrer specifically wants the client to see that
      practitioner or practitioners within that business prior to them making
      a booking

This helps to establish the client's expectations and ultimately trust in the
process

                                                 WORKING FOR A FITTER, HEALTHIER AUSTRALIA
Practical application and tips - letters
Four short, punchy, and purposeful paragraphs! (start with
existing clients!)


Subjective – what did the client tell you they want? Their
goals.


Objective – what did you measure?
Waist, mass, fitness measures, pre-ex screen, etc.


Assessment – typically a diagnosis – what is your
summary?


Plan – what will you do? And when will you report back?
                                                WORKING FOR A FITTER, HEALTHIER AUSTRALIA
Practical application and tips

And always remember:
People first – professionals second – business last




                                      WORKING FOR A FITTER, HEALTHIER AUSTRALIA
WORKING FOR A FITTER, HEALTHIER AUSTRALIA
Thank You!




       WORKING FOR A FITTER, HEALTHIER AUSTRALIA

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Filex 2012 building referral networks presentation

  • 1. Building successful Referral Networks WORKING FOR A FITTER, HEALTHIER AUSTRALIA
  • 2. Agenda Introduction – recent history Why a focus on referral networks Fitness a valuable player in Health landscape Current state of referral opportunities for Fitness Submission for Evidence based strategies Feedback from Health sector and practical application WORKING FOR A FITTER, HEALTHIER AUSTRALIA
  • 3. Recent history of Fitness on Health map 2010 – Government funding for Healthy Communities initiatives. Saw roll out of funding for the Lift for Life program 2011 – Introduction to the Adult Pre-exercise Screening System (APSS) 2012 – Further opportunities for integration into Health Networks WORKING FOR A FITTER, HEALTHIER AUSTRALIA
  • 4. Recent history of Fitness on Health map Fitness industry has not traditionally engaged effectively with health and medical services. No uniform method for engagement. Beginning with standardised screening process is a positive step. Clear absence of a systematic, effective approach to referral. WORKING FOR A FITTER, HEALTHIER AUSTRALIA
  • 5. Recent history… Locally, Active Script and Lifescript programs - government funded initiatives  Focused on capacity building and awareness-raising amidst GPs The Green Prescription program in New Zealand  Focused upon GP engagement and referral to activity providers The General Practice Exercise Referral Scheme undertaken by the Sutherland Division of General Practice and the Sutherland Shire Council (NSW)  Focused on referring individuals to facility based programs and activities WORKING FOR A FITTER, HEALTHIER AUSTRALIA
  • 6. Recent history… Government funded initiatives and research have collectively led to improved knowledge and understanding of what can work and why. For example, we now know:  85% of the pop visits a GP at least once per year  the average person makes 5.4 visits per year (2008/09)  60% of patients were 45+ years, 80% of them with a chronic condition  GPs believed to have the most significant influence on lifestyle decisions  behaviour can be significantly affected through brief consultations with GPs  GPs are first point of contact for a referral, with 13% of all visits including a referral – 28% of these to allied health (Physio, Psych, Pods, Diet, etc.) WORKING FOR A FITTER, HEALTHIER AUSTRALIA
  • 7. Recent history… Research has also helped to identify the features of a successful referral model. These include:  Strong relations between providers and GPs  GP knowledge around physical activity and exercise  Having a central point for referral, having an enabler/ coordinator role  Electronic and hard copy support resources  A clear definition of duty of care for GPs and exercise providers  Provision for specific populations  Training and quality assurance of providers  Good access to affordable local programs and providers WORKING FOR A FITTER, HEALTHIER AUSTRALIA
  • 8. Recent history… A number of detailed resources that contribute to an informed understanding of Exercise Referral have been developed for GPs in Australia: The RACGP’s red book and green book provide an outline of evidence and process for GP referral to preventative activities such as physical activity. The RACGP SNAP population health guide to behavioural risk factors in General Practice is another resource that provides guidance. WORKING FOR A FITTER, HEALTHIER AUSTRALIA
  • 9. Recent history… It is evident that considerable investment and effort has been made to better understand and progress the development of exercise referral in the past, HAVE YOU EXPERIENCED THE BENEFIT OF THIS?? A clear need for a sustainable broad-based method for referral between health and exercise services still remains. WORKING FOR A FITTER, HEALTHIER AUSTRALIA
  • 10. Fitness Industry Association Initiative Recent funding submission to the Department of Health and Ageing: Develop and test a multi-disciplinary exercise referral system within the new Medicare Locals (primary care health network setting). Several other stakeholder organisations have supported the submission. 1. Evidence collection of existing schemes 2. Consultation process with relevant associations  RACGP  SMA  APA  DA  ESSA 3. Pilot – focus on Medicare locals WORKING FOR A FITTER, HEALTHIER AUSTRALIA
  • 11. Why focus on referral networks Changing face of population health – are we adapting? Desire from medical and allied health sectors – but also barriers. WORKING FOR A FITTER, HEALTHIER AUSTRALIA
  • 12. Fitness in Health landscape Changing face of population health – are we adapting? WORKING FOR A FITTER, HEALTHIER AUSTRALIA
  • 13. Fitness in Health landscape Changing face of population health – are we adapting? WORKING FOR A FITTER, HEALTHIER AUSTRALIA
  • 14. Fitness in Health landscape Changing face of population health – are we adapting? WORKING FOR A FITTER, HEALTHIER AUSTRALIA
  • 15. Current state of referral opportunities for Fitness Industry Barriers? Awareness of service providers Awareness of quality Fears over liability Lack organised referral system WORKING FOR A FITTER, HEALTHIER AUSTRALIA
  • 16. Current state of referral opportunities for Fitness Industry the positive, negative, positive sandwich… Positive: You are passionate and enthusiastic about health and fitness Negative: Your approach and business process is not structured and measurable Positive: You are an inspirational person who can motivate people to change WORKING FOR A FITTER, HEALTHIER AUSTRALIA
  • 17. Barriers to referrals Fears over liability Recent ‘Australian Doctor’ Journal article: Mounting requests for 'fit to exercise' certificates have led to accusations gyms are shifting liability onto doctors for training-related mishaps. "The problem is you don't know what the exercise program is, you don't know how experienced the person writing the program is, and you don't know if the patient has some underlying problem” “the lack of consistency between fit-to-exercise forms was a concern, with certificates often vague or open-ended.” WORKING FOR A FITTER, HEALTHIER AUSTRALIA
  • 18. Practical application and tips  Standardised screening and referral tool  Clearance vs guidance language  Re-assessment tool of modifiable risk factors (Stages 2 and 3)  Focus on follow through on information collected Webinar 17th May 11am-12pm WORKING FOR A FITTER, HEALTHIER AUSTRALIA
  • 19. Practical application and tips  Positive and professional first impression for client and medical or allied health professional  Demonstrates commitment to evidence-based industry standards, nationally recognised procedures and legal obligations – as per other professionals in health sector  Helps to build client and professional trust, rapport and communication  Guide to defining scope of practice - operating outside of scope is a common reason for conflict with other professions  Demonstrates commitment to a client-centred approach WORKING FOR A FITTER, HEALTHIER AUSTRALIA
  • 20. WORKING FOR A FITTER, HEALTHIER AUSTRALIA
  • 21. Medicare Locals Replacement for Divisions of General Practice Primary health care organisations Established to tackle local health care needs and service gaps Opportunities for education and networking www.yourhealth.gov.au WORKING FOR A FITTER, HEALTHIER AUSTRALIA
  • 22. Practical application and tips Allied Health Professional (AHPs – Physio, Pod, Chiro, Diet, Psych, etc.) They WANT to hear from you They look for further support for their patients If in private business they NEED referrals from you!! WORKING FOR A FITTER, HEALTHIER AUSTRALIA
  • 23. Practical application and tips Allied Health Professional (AHPs – Physio, Pod, Chiro, Diet, etc.)  Have a working relationship established (ideally prior to the initial referral being made).  Sound working knowledge of how the professional works, from the basic practicalities such as: Costs Opening hours Locations  Individual knowledge base (particular strengths and weakness)  What particular client groups they enjoy working with. Ensure client is well prepared for referral experience! WORKING FOR A FITTER, HEALTHIER AUSTRALIA
  • 24. Practical application and tips Allied Health Professional  Ideally involves meeting face to face to establish these things  Observe each other in practice “I encourage the fitness professional to visit our clinic to see first hand the way we manage clients from the initial phone call to the assessment and ongoing treatment process. A complete understanding of these things enables the referral to be set up for success from the outset and trust in the person being referred to.” WORKING FOR A FITTER, HEALTHIER AUSTRALIA
  • 25. Practical application and tips Allied Health Professional (AHPs – Physio, Pod, Chiro, Diet, etc.)  Gain written, informed consent to communicate from the client  When referring, communicate (via phone, email, letter or fax prior to the client arriving for their assessment) about:  The reason for the referral  and what they and the client want to get from AHP.  Expectation for regular progress reports, specifically about identified goals (Short and objective)  Prompt reply to communication when appropriate (within 24 hours/business day) WORKING FOR A FITTER, HEALTHIER AUSTRALIA
  • 26. Practical application and tips Allied Health Professional  Client must have a good understanding of why the referral process is necessary  Client should be informed of practical things like the location, costs, appointment times, waiting times;  what to expect within the assessment and treatment process  and why the referrer specifically wants the client to see that practitioner or practitioners within that business prior to them making a booking This helps to establish the client's expectations and ultimately trust in the process WORKING FOR A FITTER, HEALTHIER AUSTRALIA
  • 27. Practical application and tips - letters Four short, punchy, and purposeful paragraphs! (start with existing clients!) Subjective – what did the client tell you they want? Their goals. Objective – what did you measure? Waist, mass, fitness measures, pre-ex screen, etc. Assessment – typically a diagnosis – what is your summary? Plan – what will you do? And when will you report back? WORKING FOR A FITTER, HEALTHIER AUSTRALIA
  • 28. Practical application and tips And always remember: People first – professionals second – business last WORKING FOR A FITTER, HEALTHIER AUSTRALIA
  • 29. WORKING FOR A FITTER, HEALTHIER AUSTRALIA
  • 30. Thank You! WORKING FOR A FITTER, HEALTHIER AUSTRALIA