PHNs transitioned to the new world of commissioning which sees them funding and subcontracting health care and other services on behalf of the Australian Government rather than delivering them directly.
The healthcare commissioning model in Australia is designed as a continual and iterative cycle involving the development and implementation of services based on planning, procurement, monitoring, and evaluation. Clinical commissioning specifically provides a roadmap for systematically linking identification of health needs and priorities and quality service availability. The focus is on outcomes to ensure continuously improving services that deliver the best possible quality and outcomes for patients, meet population health needs and reduce inequalities within available resources.
Rethinking How Health Services Are Commissioned
Changing healthcare needs can require commissioning approaches that move beyond traditional service models. Effective healthcare commissioning considers population needs, available evidence, service capacity, community perspectives, and opportunities for collaboration when determining how services should be designed and delivered.
Building Stronger Partnerships Across the Health System
New ways of working often depend on organisations being willing to share knowledge, coordinate responsibilities, and develop solutions together. Strong partnerships between government, healthcare providers, community organisations, and other stakeholders can support more integrated health services and reduce fragmentation across the system.
The overall health care gains sought are value, quality, efficiency and effectiveness, and to this end, the issues of business governance and clinical governance are critical.
From a PHN perspective, the key considerations for commissioning include:
- Efficiencies (less in administration of programs, and more to the patient)
- Cost effectiveness (value for money)
- Quality and safety
- Meeting service gaps and health priorities
- Risk management
- Engagement / commissioning of appropriate parties
- Workforce support and availability
- Client centred vs practitioner focused
From a practice perspective, the key considerations for commissioning include:
- Clinical governance and oversight mechanisms
- Knowing your population and its needs (identifying gaps)
- Clinical contracts and legal requirements
- Policies / procedures relating to the area being tendered
- Service model design and referral pathway
- Sourcing the staff / contractors (future workforce)
- IT / IM capabilities
- Data collection and reporting
- Know what it costs to deliver a service – per unit cost
- Model cost (including infrastructure and program support)
- Advertising and marketing
- Demand management of referrals
We can support health services to conceptualise opportunities and funding submissions to PHNs, and support their business growth and development.
Using Evidence to Inform Commissioning Decisions
Commissioning decisions are stronger when they are informed by evidence about population needs, service performance, stakeholder experiences, and outcomes. Health service evaluation can help commissioners understand what is working, identify gaps, and determine where changes to service models or investment may be needed.
Conclusion
Healthcare commissioning is increasingly about creating services that are responsive to changing needs and capable of working across organisational boundaries. By combining collaboration, evidence, stakeholder perspectives, and evaluation, commissioning organisations can identify new ways of working and support more coordinated, sustainable, and effective health service delivery.
Frequently Asked Questions
Healthcare commissioning involves understanding population needs, determining service priorities, designing or purchasing appropriate services, and monitoring whether those services are achieving their intended outcomes.
Why are new approaches to healthcare commissioning needed?
Changing population needs, evolving models of care, workforce pressures, service gaps, and increasing complexity can require commissioning organisations to consider more flexible and collaborative approaches to service delivery.
Evidence can help commissioners understand population needs, assess service performance, compare potential approaches, and make better-informed decisions about resources and future service delivery.
Commissioning can encourage organisations to work across traditional service boundaries, establish shared priorities, improve referral pathways, and develop models that connect different parts of the health and community care system.
Service redesign involves reviewing how a service operates and identifying changes that could improve access, efficiency, experience, coordination, or outcomes while responding to the needs of the population.
Evaluation can provide evidence about implementation, outcomes, stakeholder experiences, and service effectiveness. Commissioners can use these findings to refine existing services and inform future investment decisions.