Early interventions for healthy ageing

The Australian Government Department of Health, Disability and Ageing funds North Western Melbourne Primary Health Network (NWMPHN) to support older people to live at home for as long as possible.

The Early interventions for healthy ageing (EIHA) program commissions activities and models of care for chronic disease management to support healthy ageing and reduce pressure on hospitals, aged care and other health services.

Phase 1 (completed)

NWMPHN commissioned 10 general practices to develop and implement models of care that aim to:

• identify and engage people aged at least 50 (or Aboriginal and Torres Strait Islander adults aged at least 35) who are at risk of or have one or more chronic conditions
• provide a proactive and prevention-focused model of multidisciplinary care, to promote healthy ageing at no cost to patients.
• examine how flexible block funding can complement Medicare Benefits Schedule (MBS) fee-for-service funding, to enable this model.

Phase 2

This phase involves eight general practices. It builds on Phase 1 findings by strengthening early support and improving how different health professionals work together to manage chronic conditions in primary care. It focuses on:

• identifying health concerns earlier and providing timely support for both physical and mental health
• supporting people to better manage their own health through tailored care and guidance
• improving coordination between GPs, allied health, and community services to reduce avoidable hospital visits.

Program insights

An independent evaluation by Impact Collaborative was conducted. It comprised consultations and focus groups using all participating practices, augmented by 34 patient surveys and five patient interviews.

Evaluation findings

• The program is helping people stay healthier for longer, by identifying health concerns earlier and providing the right support.
• People receive care from a team of health professionals, making it easier to get coordinated, whole-person care in one place.
• Patients benefit from longer, more personalised appointments, giving them time to talk about what matters most to their health and wellbeing.
• Services are tailored to local communities, ensuring care is relevant, accessible, and culturally appropriate.
• The program is improving access for people who may find it harder to get care, including priority and vulnerable groups.

These findings helped shape and improve the program for Phase 2, plus inform similar initiatives across NWMPHN.

What people said during the evaluation process

The program has really helped me to live on my own, without it I would lose my support network.” – Patient

“The program has given me confidence to do something for my health, and it makes me happy to see improvements.” – Patient

“The EIHA program has allowed us to deliver interventions that are otherwise inadequately paid for by Medicare.” – Clinic staff member