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Eligibility for Care Plus

Care Plus funding is provided to general practices to improve chronic care management, reduce inequalities, improve primary health care teamwork and reduce the cost of services for high-need patients.

A general practice that is part of a PHO can enrol a patient in Care Plus if they are assessed by a doctor or nurse at the general practice as:

  • being able to benefit from intensive clinical management in primary health care (at least two hours of care from one or more members of the primary health care team over the following six months), and
  • having two or more chronic health conditions, as long as each condition is one that:
    • is a significant disability or has a significant burden of morbidity, and
    • creates a significant cost to the health system, and
    • has agreed and objective diagnostic criteria, and
    • requires continuity of care and where a primary health care team approach has an important role in management, or
  • requiring intensive clinical care because they:
    • have a terminal illness (defined as someone who has advanced, progressive disease whose death is likely within 12 months), or
    • have had two acute medical or mental health-related hospital admissions in the past 12 months (excluding surgical admissions), or
    • have had six first-level service or similar primary health care visits in the past 12 months (including emergency department visits), or
    • are on active review for elective services.

What Care Plus provides

The provision of Care Plus varies between PHOs, and in some cases it varies between practices within the same PHO.

In general, a Care Plus patient can expect an initial comprehensive assessment where their health needs are explored in more depth. An individual care plan should be developed to set realistic, achievable health and quality of life-related goals, with regular follow-ups. People using Care Plus will get effective management of chronic health conditions, better understanding of their conditions and support to make lifestyle changes.

Care Plus services are usually provided at a low or reduced cost.

Care Plus and the High User Health Card

Care Plus differs from the HUHC in that it coordinates a comprehensive approach to improve outcomes for people with chronic conditions, including lower cost access, whereas the HUHC is a subsidy approach tied to GP visits.

Care Plus funding

Overall funding allows for 5% of the New Zealand population to be Care Plus patients.

Care Plus funding is based on a capitation formula, and the level of funding paid to PHOs is dependent on the percentage of the eligible number of Care Plus patients receiving Care Plus services.

The level of funding that a PHO receives increases as the PHO enrolls more Care Plus patients.