1. Patient Centred Health Care Home
Kainga Hauora

2. 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

3. 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.

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

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

6. 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)

7. 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

8. 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

9. 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

10. 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

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

12. 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,

13. Outcome indicators (CCDHB dashboard)

17. Predictive risk algorithms: We can forecast risk of hospitalisation

18. Health Care Neighbourhood

19. Technology

25. ICT in health Cognitive computing IBM Watson

28. $2m investment from Waikato

29. 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?

30. 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

31. 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

32. 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

33. 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,