Health Policy 69 (2004) 215–228 Introducing coordinated care (2): evaluation of design features and implementation processes implications for a preferred health system reform model Leonie Segal a,* , David Dunt b , Susan E. Day a a Centre for Health Economics, Monash University, P.O. Box 477, West Heidelberg, Vic. 3081, Australia b Program Evaluation Unit, School of Population Health, University of Melbourne, Melbourne, Vic. 3010, Australia Abstract The study investigated why the goals of the Australian Coordinated Care trials for clients with complex care needs were not achieved. Significantly higher health service use and costs were incurred in the absence of clear evidence of improved client health outcomes. The validity of assumptions underpinning trial design and the success of implementation at each step in application of the model were examined. There were failures in both design and implementation. Many clients did not require care coordination. The funds pooling arrangements contributed to limited possibilities for service substitution and training of GP care coordinators was inadequate. Trial design did not focus on either clinical guidelines or consumer empowerment. Furthermore, the expectations of the overall national trial were unrealistic both in trial design and expected outcomes given the rigidities and realities of the Australian health care system. Broader system reform in the form of funds pooling and health services planning at the regional level, based on large populations, may be a more effective means to address problems of care coordination and an inflexible supply system. © 2004 Elsevier Ireland Ltd. All rights reserved. Keywords: Care coordination; Implementation; GP perceptions; Client perceptions; Funds pooling 1. Introduction The Southern Healthcare Network Coordinated Care Trial (SHCN CCT) was one of a series of health funding and delivery reform experiments that formed the Australian Coordinated Care Trial. The SHCN CCT aimed to promote a more appropriate use of health services through coordination of care for clients with recent high in-patient use, leading * Corresponding author. Tel.: +61-39496-4433; fax: +61-39496-4424. E-mail address: lsegal@connexus.net.au (L. Segal). to better health outcomes; and to achieve this within current level of resources, supported by the establish- ment of a single funds pool to pay for health service use by trial clients. A randomised control design was employed with clients allocated on a 3:1 ratio to re- ceive care coordination (CC) or usual care. For those in the CC arm, an individual care plan was developed by their general practitioner (GP). Access to a service coordinator or case manager was provided to higher risk clients, as determined by their risk assessment score derived as part of the care-planning task. Health care services were purchased from pooled funds of participating health care agencies. 0168-8510/$ – see front matter © 2004 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.healthpol.2004.02.001