HIP Alignment Jackie Kearney February 2013

Overview Responding to demographic changes The journey so far Why change Why now Your concerns Where to from here – working together

Demographics Our population is: Increasing Getting older Experiencing more chronic illness Have higher expectations then ever before Want to stay at, or close to, home Using more hospital services

The role of HIP in the health system- substitution and diversion Aim to provide least restrictive care option  Directly admit to subacute  Care at home  Ambulatory Right Place Right Care Right Cost Right Time

Responding to the demographics –thinking differently The Health Independence Program is a model of care not a discharge destination ‘Demand for HIP services will increase as future health services’ and consumer expectations continue to demand more emphasis on community treatment (p1)’

The journey so far HIP guidelines (2008) –Promote interdisciplinary care –Integration and streamlining of programs to achieve better continuity of care for clients Subacute Planning Framework (2009) –Capability framework for levels of service and expected suite of services –Regional self sufficiency –Informs department service development and funding allocation decisions

Preparing for future demand Common processes and core principles Using skilled workforce more effectively and efficiently Minimise duplication – for staff – for clients Build flexible and multi-skilled workforce to deliver care in a variety of settings Delivered based on client need and not by program boundaries About managing demand in restrained economic climate (P3)

HIP Objectives The HIP objectives are to:  simplify the service system  produce efficiencies  minimise duplication  improve equity  enhance co-ordination  reduce fragmentation  flexibility in service delivery

Processes supporting the HIP model of care 2008/09: Health services asked to submit a HIP Implementation Plan 2009/10: Progress report for access; initial needs identification; appropriate setting; and corporate governance 2010/11: Progress report for assessment; transition and exit; interdisciplinary approach; and care coordination

A HIP funding stream

Funding approach……..from this …to this

Why Now? Feedback from services Significant progress in implementation of guidelines by the sector  It is the next step  Assessment suggest program streams are limiting integration Opportunities for greater integration Change focussed on model of care  Model supported by ABF funding approach not driven by it  clearer picture for services of their activity  change is coming – be the driver not the passenger

Concern 1 ‘Our service does not have the capacity to deliver full suite of services’ Continue to deliver what you are funded for. Existing relationships can continue – use the transition period to see where improvements in integration can be made. Suite of services you are required to deliver is based on the SCF

Concern 2 “We all report different things” In the PAC SACS and HARP villages different languages are spoken. ABF is introducing a new national language. It will become the dominant language HIP will provide the common language for the components of care ABF will provide the language for reporting activity = Service Event Over time we will move to a common language

Concern 3 “We will shift to cheapest model of care” Same clients just different funding approach Clinical need should drive care not funding streams Funding should support efficient care – HIP objectives aim for this We will monitor maintenance of effort

Concern 4 “We have different geographic catchments and eligibility criteria” Service development is based on local need and existing relationships – often historical Opportunity to review what is working and what needs changing Process to align catchments and eligibility Use the transition period to support this It will not be a ‘one size fits all’

Concern 5 “Our service won’t flow the funding to the health independence program” Funding will flow to your health service identified as HIP The department sets and monitors activity not expenditure at program level Health services will continue to allocate budgets internally Same budget - block funded – transitional in line with ABF approach

Addressing the concerns – risk management What the department will do: Provide program reports to health services In the reports will: – Provide activity via service streams –Give you an overall HIP activity report –Shadow the new national Service Event activity language Monitor maintenance of effort Working with you to define and clarify components of care – opportunities to benchmark Clear departmental expectations detailed in the Policy and Funding Guidelines

What next Afternoon workshops will ask you to focus on exploring the components of care delivered in the HIP Discussion paper informed by today and will identify key issues and implementation steps Working with health services to identify implementation steps based on current readiness including aligning boundaries Ongoing conversation between services and DH to guide further implementation, including the alignment of Residential In-Reach funding. Continue to meet as program to discuss and develop model.

Key Messages Part of the HIP journey – this is a transition time No overall reduction in HIP funding across system as a result of the consolidation Clinical needs should determine care not funding boundaries ABF is a potential enabler for the care you want to deliver DH will monitor maintenance of effort One size will not fit all Aim to remove boundaries to improve service delivery

To conclude – your job this afternoon The model of care we are working towards Better articulating the components of care that make up HIP