Coordinated
support when
you need it most

CarePoint

Sometimes you need an extra level of care to navigate the complexities of the healthcare system.
CarePoint provides extensive support for people with difficult-to-manage or long-term health conditions. The goal is to help you stay safe and well at home, without unnecessary hospital stays.

We're focused on your unique
and holistic health needs


The CarePoint program is for people with various and ongoing health concerns. You may have been hospitalised or been to an emergency department due to problems related to a condition like diabetes, asthma, heart failure or chronic obstructive pulmonary disease.

We partner with your healthcare team

Your CarePoint team works closely with your GP and practice staff to help you access the right support and resources you need.

Support services include:

  • a home assessment
  • a dedicated Care Coordinator develops a personalised care plan specific to your needs and provides ongoing support
  • additional telephone support by a Care Navigator to help connect you to the right resources and support
  • help to better understand and manage your medicines, symptoms and other health related needs
  • 24×7 nurse hotline for after-hours questions.

Program duration

CarePoint runs for two years, to develop and implement a comprehensive health plan to support lasting change.

What participants are saying…

They look into the vital parts, the things that mean the most – your health and how to manage yourself.”

How we help: Belle’s story

Belle is 81 and has osteoarthritis, osteoporosis, 
bilateral knee joint replacements and urinary track infections.

“I got help. I got immediate assistance for what I needed, at home.”

Belle had fallen several times recently and had frequent urinary tract infections, but she hadn’t mentioned either to her doctor so they kept happening. Her urinary tract infection symptoms got so bad that she had to go to hospital.

Support included:

Fast-tracked home assessment by an occupational therapist and assistance to reduce falls including:

Helping Hand Care Point Icon
  • a referral for council-funded personal care to help reduce fatigue
Mobility Support Care Point Icon
  • a walking frame and equipment to help Belle get in and out of bed safely.

Results:

  • Belle’s Care Coordinator worked closely with her doctor to help Belle stay well and out of hospital.
  • On one occasion Belle rang her Care Coordinator to say she had a temperature and no appetite and thought she should go to hospital as she had no way of getting to see her doctor.
  • Belle’s Care Coordinator talked to her doctor who arranged a home visit that day. Belle began antibiotics for her urinary tract infection and was able to recover at home. She now accesses urgent GP appointments and after hours visits and has been able to stay out of hospital.

Patient’s name and photo have been changed for privacy purposes.

If you would like to know more about CarePoint, talk to your GP.

Evidence that
CarePoint works

CarePoint is based on international best practice strategies that have been shown to reduce hospital admissions and average time in hospital.(1-6)

A major study that looked at 29 trials with more than 5,000 patients with heart failure found that the approach CarePoint is modelled on led to 25 per cent drop in hospitalisations.1, 2 Another study found that this approach halved the amount of days people spent in hospital.3 A study in Victoria showed a big drop in both emergency department visits (down 35%) and admissions (down 53%).6

CarePoint has been modelled on the features that made these programs successful.

References: 1. Scott IA. Public hospital bed crisis: too few or too misused?, 2010, Aust. Health Review 34, 317–324. 2. McAlister FA, et al. Multidisciplinary strategies for the management of heart failure patients at high risk for admission: A systematic review of randomised trials, 2004, Journal of the American College of Cardiology, Vol 44 (4): 810–819. 3. Claffey TF, et al. Quality In Maine Medicare Advantage Plan Health Affairs, 31, no.9 (2012): 2074–2083. 4. Brown, R.S., et al. Six Features Of Medicare Coordinated Care Demonstration Programs That Cut Hospital Admissions Of High-Risk Patients. Health Affairs, 2012. 31(6):p. 1156–66. 5. Darkins A, et al. Care Coordination/Home Telehealth: The Systematic Implementation of Health Informatics, Home Telehealth, and Disease Management to Support the Care of Veteran Patients with Chronic Conditions Telemedicine and e-Health. December 2008, 14(10): 1118–1126. 6. Victorian Government Department of Human Services: Improving care Hospital Admission Risk Program. Public report, 2006.