Summary of Honeysuckle Health settlement

All agreed conditions specifically relate to the Honeysuckle Health buying group activities. These conditions do not limit: 

  • the activities nib is permitted to engage in, in its individual capacity; 

  • the services that Honeysuckle Health (HH) is permitted to provide to a PHI on an individual basis; or 

  • the activities of nib, HH or the HH buying group beyond the period of the authorisation. 

These conditions supplement the decision of the Australian Competition and Consumer Commission that limit the period of authorisation to five years and exclude the major health funds from participation in the HH buying group, 

1. Continuation of the medical gap scheme

Agreement was reached that nib or HH would continue to offer a medical gap scheme to participants of the HH buying group with the following assurances:  

  • No obligation to provide any data to HH or nib beyond that required to verify claims. 

  • No requirement for medical specialists to: 

    • discharge patients to home care; 
    • refer patients to particular specialists or specialists from a particular group; 
    • refer patients to particular allied health services; 
    • treat patients at particular facilities or facilities in a particular group. 
  • No targets or any right to terminate based on failure to meet targets. 

  • No incentives (financial or otherwise) for performance or patient outcomes apart from the existing fees payable.  

  • Continued right of specialists to opt out of the medical gap scheme for individual patients. 

  • No confidentiality requirements. 

2. BCPP and other agreements with medical specialists 

Agreement was reached that HH will only offer the BCPP and any other agreement to participants of the buying group if the agreement has the following protections: 

  • No requirement that medical specialists have regard to any clinical guidelines beyond those developed by a recognised specialist body. 

  • Agreements will expressly acknowledge:

    • that the application of clinical guidelines must be done with regard to the best interests of patients; 
    • the clinical independence of participating medical specialists; 
    • that there will be no interference in the clinical independence of the medical specialist. 
  • Consent must be obtained from the patient to collect and disclose patient data beyond that required to verify claims and additional protections for medical specialists that choose not to disclose this data. 

  • A medical specialist cannot be required to do any of the following (and cannot be financially penalised if they do not do any of the following) if in their view it is not in the best interests of the patient: 

    • apply clinical or treatment guidelines; 
    • discharge the patient to home treatment; 
    • refer the patient to particular medical specialists or allied health providers. 
  • Medical specialists can disclose agreements and their terms (aside from terms relating to pricing) to patients, AMA and their insurers. 

  • No targets or any right to terminate based on failure to meet targets. 

  • No incentives provided to medical specialists beyond payments for participation in, and facilitation of quality assurance activities. 

3. Compliance monitoring 

The parties have also reached agreement on a reasonable audit procedure as well as a dispute resolution procedure for an alleged breach of the terms of the deed. This will help to ensure ongoing compliance.