Support to develop skills to improve and manage your health


CareFirst is an extensive support program that works with your health professionals to help you build new skills to manage your chronic condition.
With personal coaching your CareFirst team will help you achieve your health goals and make changes that last.

We’re focused on empowering you
to manage your condition

CareFirst is for people diagnosed with one of the following chronic conditions:

Chronic Heart Failure

We partner with your healthcare team

Your Care Coordinator works together with your GP and other health professionals to develop a care plan and support you towards your health goals.

Support services include:

  • a new or updated care plan tailored to your specific needs
  • a series of health coaching sessions to help you develop and achieve your health goals
  • phone calls from a Care Navigator to help you keep on track
  • an information pack about your condition(s)
  • a health advice line for any questions or concerns
  • six-months access to online resources to help you achieve and maintain your improvements.

Program duration

CareFirst runs for six months including a 16-week ‘intensive phase’, which includes a mix of face-to-face coaching visits and phone calls from a Care Navigator.

The program concludes with a review of your health goals.

How we help: Marg’s story

Marg is 69 and has asthma, coronary heart disease, type 2 diabetes and osteoarthritis.

“I finally have the right care team around me – I have lost weight and my waist measurement is down. I am very happy!”

Marg is also severely overweight which has made it difficult for her to get out and about. Her conditions are not well controlled so she experiences pain and flare-ups that interrupt her life.

Marg is motivated by a desire to lose weight and be more mobile and healthy. CareFirst developed a new multidimensional care plan to help Marg reach her goals.

Support included:

  • A home medicine review. This led to a change in Marg’s medicine that has helped her get her diabetes under control.
  • Consultations with a dietitian. Marg has now reduced her portion sizes and the amount of carbs in her diet.
  • Coaching sessions to improve her ability and confidence in managing her conditions.
  • Personal training sessions to help with movement-related pain.
  • Consultations with a physiotherapist, ophthalmologist and podiatrist.


  • Marg has already lost more than three kilograms.
  • She is now consistently making healthy food choices and eating smaller portions.
  • Marg has gone from no physical activity at all to 240 minutes of exercise each week.
  • Marg is now much less likely to need to go to hospital or to develop serious complications from her diabetes.

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

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

Evidence that CareFirst works

CareFirst is based on a model of care designed for people with chronic conditions. This model has been successfully adopted across the US, UK and Australia.1-3

It draws on evidence-based guidelines and focuses on building patients’ ability and confidence to manage their conditions, as well as improving connections with resources in the community.1

Further evidence supports the self-management strategies that are key to CareFirst.3-7 A major study that looked at 29 trials with more than 5,000 patients with heart failure found that the approach CareFirst is modelled on led to 25 per cent drop in hospitalisations.4,5 Other studies have shown that key elements of CareFirst, such as providing tools, knowledge and support to manage conditions, are central to successful programs.3,6,7

Supporting self-management 

Additional evidence supports the use of self-management strategies that are central to CareFirst. An analysis of 29 international trials including over 5,000 patients found that chronic disease management programs that systematically used evidence-based guidelines, self-management strategies and multidisciplinary care reduced hospitalisation by up to 25 per cent in patients with heart failure.4,5 Providing patients with tools, knowledge and support to take control of their condition is key to high-performing chronic care programs.6,7A systematic review in Australia found that the most effective interventions offered self-management support, including educational sessions and counselling, combined with multidisciplinary teams involving registered health professionals.3

CarePoint is built on this framework.

References: 1. Bodenheimer T, et al. Improving primary care for patients with chronic illness: The chronic care model, part 2. JAMA, 2002. 288(15): p. 1909–1914. 2. Singh, D. and C. Ham, Improving care for people with long-term conditions: a review of UK and international frameworks. 2006: University of Birmingham. Health services management centre. 3. Zwar, N., et al. A systematic review of chronic disease management. The University of New South Wales. Australian Primary Health Care Research Institute: Sydney, 2006. 4. Scott IA. Public hospital bed crisis: too few or too misused?, 2010, Aust. Health Review 34, 317–324. 5. 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. 6. Coleman, K., et al., Evidence on the Chronic Care Model in the new millennium. Health affairs, 2009. 28(1): p. 75–85. 7. 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.