1. PASIFIKA GP NETWORK
11 February 2015

2. 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

3. 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

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

5. Direction of travel for the NZ Health system

6. 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

7. 21st Century Burden of disease- Non communicable diseases

8. 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

9. 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

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

11. 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

12. Integrated Performance and Incentive Framework
Peter Jones
11 February 2015

14. 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

15. 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

16. IPIF Measures 2015 Capacity and Capability
Patient Safety and Experience of Care
HQSC developing
Australian collaboration
Online questionnaire with submenus
SMS, 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

17. 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