Health Care Homes

A Health Care Home is a general practice or Aboriginal Community Controlled Health Service (ACCHS) that coordinates care for patients with chronic and complex conditions.

A patient who is eligible can choose to enrol, and also chooses a GP - usually the GP they have already been seeing - who knows them, their health conditions and priorities. This doctor leads a care team which will look after that patient.

Together, a patient and their care team will then develop and follow a shared care plan which will:

  • set health goals
  • include strategies to help each patient better manage their conditions and improve their quality of life
  • identify the best local providers who can meet each patient’s needs

In line with this plan, Health Care Homes will also coordinate that patient’s care. For example, if a patient sees their specialist or goes to hospital, their Health Care Home will follow up. That way, they know about all the care that person receives, both inside and outside the Health Care Home.


A key component of health care homes is patient feedback on their experience and outcomes of care (PREMs and PROMs), as well as their level of activation (PAM).

You can read more about PREMs/PROMs or PAM.