Patient Centred Health Care Home Kainga Hauora

Our health system is set up to revolve services around hospitals Our health system is set up to revolve services around hospitals. Investment and funding is prioritised to the hospital. But with ageing population and increasing consumer demand this is not sustainable – expensive and delivers poorere outcomes than a primary care oriented system

Coordination Expanded primary care team Our new picture might look more like this. The services we use most often are clustered together to be comprehensive, team based, person centred and accountable, and the general practice team coordinates access to other services.

Primary Care: Barbara Starfield Accessible Continuous care over time Person centred rather than disease centred Coordinating care between providers Comprehensive

Health Care Home: Model of Care Principles Core elements Patient/whanau centred Continuity of care Coordinated Comprehensive Accessible & equitable Accountable

Health Care Home Development & Challenges Pinnacle CCDHB ProCare Pegasus Northland 26 Practices / 135,000 patients 9 practices (in dev) / 68,000 pts 4 Practices (in dev) 51 practices in IFHS dev program, 240,000 pts 6 Neighbourhood Health Care Home (in dev)

Timely unplanned and urgent care Standard Patient experience Call management, GP triage/ tel consult Same day appointment Extended workforce response Shared health record Enhanced acute services (POAC) My call gets answered I can talk to a GP & get treatment over the phone I get a same day appt if I need one If I go to A/H, ED they can see my record I can get acute care (IV therapy, etc) at my practice Headline 2013 numbers from the workforce census. Waikato 56% of MHN practices 64% of all GPs 62% of all PNs 62% of all enrolled patients Taranaki 35% of practices 23% of GPs 28% of PNs 24% of enrolled patients Lakes 4% of practices 6% of GPs 4% of PNs 8% of enrolled patients Tairawhiti 6% of PNs 6% of enrolled patients

Proactive care for people with complex needs Standard Patient experience Population stratification Shared care planning for complex patients Care coordination Self management support Patient centric scheduling Extended health team & links with social care/whanau ora The team understand my needs and health goals My providers work together with my GP team I get support to manage my long term condition(s) I get the time I need Health and social services work together Headline 2013 numbers from the workforce census. Waikato 56% of MHN practices 64% of all GPs 62% of all PNs 62% of all enrolled patients Taranaki 35% of practices 23% of GPs 28% of PNs 24% of enrolled patients Lakes 4% of practices 6% of GPs 4% of PNs 8% of enrolled patients Tairawhiti 6% of PNs 6% of enrolled patients

Planned Routine & Preventative care Standard Patient experience I can access services thru patient portal, book appointments, get scripts, have e-consults and see my GP notes GP organises lab tests etc in advance - my time is valued GP team helps ensure care is affordable I get support to stay well Patient portal, e-consults Pre-work – telephony off front desk Extended hours availability Wider health team (HCA, clinical pharmacist, etc) Support for self care / self management Managed affordability Headline 2013 numbers from the workforce census. Waikato 56% of MHN practices 64% of all GPs 62% of all PNs 62% of all enrolled patients Taranaki 35% of practices 23% of GPs 28% of PNs 24% of enrolled patients Lakes 4% of practices 6% of GPs 4% of PNs 8% of enrolled patients Tairawhiti 6% of PNs 6% of enrolled patients

Business Efficiency & Accountability Standards Patient experience Enhanced team roles Use standard work/standard consult rooms Team based continuous improvement & performance benchmarking Regular measurement of patient experience My time is valued – I don’t have to wait, don’t have to come in My experience is valued The quality of services provided to me keeps getting better

CCDHB cost assumptions for flexible funding CCDHB cost assumptions for flexible funding. Plus $20k per practice for change costs.

Financials Pinnacle: Flexible funding pool CCDHB: $16 per patient DHB, $14 PHO contribution Northland: $16 per patient DHB, $14 PHO contribution Pegasus: DHB contribution to facilitation ProCare: limited DHB contribution, but ARI $ There are 2 financial issues – the cost of supporting change, and the cost of new models of care,

Outcome indicators (CCDHB dashboard)

Predictive risk algorithms: We can forecast risk of hospitalisation

Health Care Neighbourhood

Technology

ICT in health Cognitive computing IBM Watson https://www.youtube.com/watch?v=WFR3lOm_xhE

$2m investment from Waikato

Network Dis-intermediation National Enrolment Service Aim to move to pay GPs directly - like pharmacies? Erodes network support and bargaining power Become price / condition takers?

Health Care Home Model of Care: Clinician Perspective My working day is calmer I’m able to use my skills effectively more of the time I feel we’re more of a team I have time to manage virtual consulting I feel we have a practice plan rather than ad hoc changes I feel in control of my day I feel better connected to other providers involved in my patients care My daily schedule is more varied I feel I am giving a better service

Health Care Home Model of Care: System Perspective Acute care is better planned reducing hospital activity Better co-ordinated care is reducing need for ad hoc care Primary Care resource is more efficient creating more capacity General practice is more sustainable A standardised primary care model in which to invest Recruitment and retention is improved Shared electronic record is the norm Better value for the health $ Development of standardised primary care performance data framework for health and social care integration

Health Care Home Collaborative RNZCGP, DHBs, MoH, PHOs actively implementing HCH Share learnings and resources Support local implementation Develop Accreditation standards National policy development to support HCH National evaluation and benchmarking

Financials Cost of change Cost of new care proceseses Time out, Facilitation, technology Cost of new care proceseses Tel consults, e-consults, prework Care assessments and planning Cost of new roles: Clinical pharmacy Cost of community and social care integration Interdisciplinary meetings, facilities for use district nurses, whanu ora workers, etc There are 2 financial issues – the cost of supporting change, and the cost of new models of care,