PASIFIKA GP NETWORK 11 February 2015

MoH Strategic Priorities Better integrate services within health and across the social sector “Health is a social issue with medical outcomes” It is key to improving equity. Alliances Regionalisation Transition between services eg: between Health and Education when children turn 5; between hospital and residential care for funding food supplements Improve the way services are purchased and provided Ensure funding models support change Building & supporting key enablers and drivers for change e.g. workforce, health information and capital

MoH Strategic Priorities Lift quality and performance Driving performance through measuring and rewarding the right things to improve quality E.g. IPFI, health targets … Support leadership and capability for change Supporting sector wide governance and capability Support and encourage ways to ensure greater community and consumer voice in a people-centred system Supporting greater public choice

MoH Strategic Priorities New Zealand Health Strategy update Funding Review Capacity and Capability Review All three to be completed by 30 June 2015

Direction of travel for the NZ Health system

Challenges The way the system manages and responds to demand makes it difficult for some people to access appropriately integrated and coordinated health care within their community, which can result in poor clinical outcomes Some service approaches still do not actively engage some of the population in the management and prevention of illness and disease The design of current healthcare business models reflects long term adaptation to historical demand; they are not configured to sustainably meet future need Underestimation of the complexity of change required to implement the health care strategy resulted in variable implementation of the strategy’s intent which is now a limitation on the system’s ability to respond to need

21st Century Burden of disease- Non communicable diseases

The sector is diverse in its appetite, capability and capacity to change (this could be a practice, a PHO or DHB) Reluctant changers: Will need convincing to change or unaware they could How do we share their experience? Fast followers: Would change if knew how or had time Have provided a good indication of key enablers of change in our system Prepare to change Dyed in the wool: Probably won’t change High performers leading change in components of health care. Driven by thought leaders (management and clinical) Help to change The “Old Way” The “New Way” Encourage to continue to change (in the right direction) Convince to change

Solutions- What are we working on… Yet to be described for our system High-level strategic direction Picture of future P&CHC state Barriers & enablers Interventions NZ Health Strategy & Triple Aim Primary Health Care Strategy Models of Care characteristics and success factors that define the future state BSMC BC Alliancing IPIFF Option 1 Option 2 Barriers and enablers to achieving the desired state Remain fit for purpose Good solutions emerging

The challenge is to shift the sector How can we support the sector/ the system to do this?

Consistent themes from national and international literature about models of care Effective triage function Clinical Governance (CQI) Enablers Access to information when needed Access to shared planning Agreed clinical pathways Access to diagnostics Access to information to drive continuous improvement Sharing of best practice and success Evidence based clinical education and leadership Funding model that target those who need it most Strong Primary-Secondary relationships Earliest and lowest level of intervention Accessible information Personalised and flexible Patient centred Team based approach Multi discipline Structured complex care Integrated, coordinated Accessible and equitable service for all Reflective of community needs Acute care Population needs addressed Move from demand to need model Barriers Capital investment constraints Legacy professional cultures Clinical and Management leadership capability Change capacity constraints Trust Interpretation of Privacy laws Collaborative approach with stakeholders Prevention services Imms wellbeing Screening Exercise

Integrated Performance and Incentive Framework Peter Jones 11 February 2015

Measures Framework System performance measures Nationally set Support high level goals of the health system Reflect performance of the system as a whole Organised according to life stages Contributory measures Selected at a local level for quality improvement Support achievement on system performance measures Measures library and guidance

IPIF Measures 2015 Improved Health and Equity for All Populations Healthy Start Healthy Ageing Registration with LMC within 12 weeks of conception Enrolment with a PHO/Practice within 4 weeks Completed all scheduled immunisations by 8 months Polypharmacy: number of people taking 11 or more medicines (no increase) Healthy Adult Cervical Screening rate Smoking Health Target Cardiovascular Disease Health Target Healthy Child 2 year immunisation rate

IPIF Measures 2015 Capacity and Capability Patient Safety and Experience of Care HQSC developing Australian collaboration Online questionnaire with submenus SMS, email invitations to those with recent contact Implementation July 2o15 Cognitive testing for NZ Pilot in 3 PHOs Support for multichannel access to clinical services % of practices using eportals Measured at PHO level Incentivised by NHITB

Incentives and Reporting Various financial incentive payment models in discussion Top slice for capacity and capability Weighting for high need Reporting disaggregated by ethnicity and deprivation Reputational incentives and tiered structure are in development