Project ACUMEN

Paying for Health,
Not Visits.

A budget-neutral pilot to demonstrate the efficacy of paying for health outcomes rather than office visits.

ACUMEN: Australian Chronic Care & Unified Medical Engagement Network

Building on a Strong Foundation

ACUMEN isn't a replacement for Medicare; it's the necessary evolution. We leverage the existing MyMedicare infrastructure to activate true outcomes-based care.

Project ACUMEN

The "Active Ingredient"

Unlocks the potential of registration by adding Outcomes-Based Payments, a Digital Sandbox for innovation, and Team-Based Care incentives.

MyMedicare

Voluntary Registration

Provides the essential patient-to-practice attribution. It formalizes the relationship and allows for longer telehealth consults, but lacks the financial levers to change clinical behavior.

Universal Medicare (MBS)

The bedrock of universal access. ACUMEN preserves this safety net while modernizing chronic care delivery.

The Hamster Wheel of Primary Care

The current Fee-For-Service (FFS) model is broken. It forces physicians to prioritize volume over value, leading to burnout and suboptimal patient outcomes.

Current State (FFS)
  • •Physicians paid for activity, not outcomes.
  • •High administrative burden (coding, billing).
  • •Innovation stifled by rigid billing codes.
  • •Patient care fragmented and reactive.
Future State (ACUMEN)
  • •Prospective payment based on patient complexity.
  • •Physicians liberated to practice medicine.
  • •Incentives aligned with health outcomes.
  • •Care is continuous, proactive, and holistic.

The Three Pillars of ACUMEN

Our approach combines payment reform, regulatory flexibility, and technology to create a sustainable primary care ecosystem.

GP Chronic Condition Management (GPCCM)

The new Medicare framework (July 2025) replaces complex "Team Care" red tape with a streamlined, automated billing cycle powered by patient data.

  • Item 967: Quarterly Review triggered by data
  • Item 965: Annual Plan auto-populated by intake
  • Eliminates "Team Care Arrangement" complexity

A New Day in Healthcare

See how ACUMEN transforms the daily experience for both providers and patients.

ACUMEN Provider Portal

Revenue Alert: Item 967 Due

3 Ready
Review Ready
Monitoring...
Monitoring...
Panel Health: 92%Next Payout: 15th

Stop Forgetting Revenue

Reviews (Item 967) are often missed. ACUMEN tracks the data and flags the patient for review exactly when they are eligible (quarterly) and stable.

  • Data-Triggered Reviews

    Wake up to a dashboard that tells you who is stable and ready for a review, based on real-time home monitoring data.

  • Automated Compliance

    Say goodbye to complex "Team Care" paperwork. The new GPCCM framework (Item 965/967) is streamlined and red-tape free.

The Economics of Prevention

ACUMEN creates a sustainable financial model where every stakeholder wins when the patient stays healthy.

Providers

Incentive
Stability + Upside
Comparison

Unpaid Admin Time
Item 967 x 4+ Item 965 (Plan)

*Automated alerts ensure reviews are never missed.

Government

Incentive
Retention (MyMedicare)
Savings

Invests ~$782 (GPCCM)
Prevents ~$8,500 (Admission)
Net ROI: 10x+

*Based on Item 965 + (4x 967) vs DKA admission.

Patients

Incentive
Zero Gap + Access
Impact

Saves ~$400/yr in gap fees
+ Subsidized Tech

*Assumes avg $40-50 gap per standard consult.

Tech Vendors

Incentive
Market Access
Model

B2B SaaS Model
~$20/mo

*Paid by practice from capitation funds.

Case Study: Type 2 Diabetes

"The Price of a Preventable Event"

Comparing proactive management vs. reactive acute care.

Annual Medicare Investment
~$782
Items 965 + (4 x 967)
Is Less Than
Single DKA Admission
~$8,500
Hospital DRG Cost

ACUMEN pays for itself by preventing just 1 in 5 high-risk events.

The Economic Impact

ACUMEN is designed to be budget-neutral in the short term and generate significant ROI through improved population health.

Budget Neutral

Reallocates existing FFS spend into capitated payments without new funding.

Positive ROI

Reduced hospitalizations and ED visits drive long-term savings.

100% Coverage

Ensures every patient has a dedicated primary care team.

Implementation Roadmap

A phased approach to ensure stability and measurability.

Phase 1: Pilot Launch

Year 1

Select 5 diverse primary care practices. Implement CDOL payments and SfO waivers.

Phase 2: Evaluation & Adjustment

Year 2

Analyze outcomes, refine risk adjustment models, and gather provider feedback.

Phase 3: Regional Scale

Year 3

Expand to 50 practices across multiple regions. Integrate Care Mesh fully.

Phase 4: National Rollout

Year 4+

Codify successful models into national policy.