2. Outline Update on localities establishment System Integration Clinical Framework Global Budget Setting Whanau Ora Networks Next Steps Questions?

4. Locality General Manager’s Lynda Irvine Manukau Sarah Marshall Mangere/ Otara Linda Bryant East Geoff Smith Franklin (30 th Dec) Kathy de Luc Franklin (2 nd Dec)

5. At Risk Individuals System Redesign Quality Improvement More Detail about the Work Programmes

6. The At Risk Individuals Programme is about 1. AT RISK INDIVIDUALS PROGRAMME more planned, proactive care

7. AT RISK INDIVIDUALS PROGRAME A number of programmes will be merged into the new ARI programme, including: CarePlus High Risk Individuals Chronic Care Management CCM Depression Self Management Education Refugee Services Diabetes Care Improvement Package 1. Lots of programmes into one

8. 1. AT RISK INDIVIDUALS PROGRAMME AT RISK INDIVIDUALS PROGRAME Risk Stratification Assessment Care Planning Funded Interventions Measuring Predictive Risk ToolCommon assessment tools Consistent care planning system Interventions clinicians can deliver or refer to in order to provide extra support to patients Evaluation and outcomes measurement Finalise predictive risk tool – agree Develop and agree budgets – input vs. outcomes Develop and agree consistent assessment tools Develop roll out plan for e-shared care Agree core set of interventions to be consistent district-wide – both value add General Practice and second tier services Disease specific outcomes Patient experience and health status outcomes Acute demand outcomes

9. 2. SERVICE REDESIGN

10. Evaluation Framework Confirm and begin implementation of an evaluation framework for Counties Manukau Health System Integration Programme Performance Metrics Develop a dashboard for system integration that will collate key quality and performance data by LCP. Learning System Clinical Audit LCPs undertake regular clinical audit programme to monitor improvements in patient outcomes Quality Quality improvement systems are established and developed in each LCP Develop quality indicators for LCPs Support LCPs to collect and analyse indicator data 3. QUALITY IMPROVEMENT IN LCPs

11. The Global Budget

13. Objectives Sharing accountability for whole of system outcomes Enhance and incentivise integrated clinical decision-making Better align service delivery with desired population health outcomes Enable improvement in capacity and capability

14. The Global Budget Operational Budget Health Services Programme Budget Locality Primary and Community Health Services Shared Accountability Services (SAS )

15. Shared Accountability Services From July 2013, we will share accountability for reducing utilisation of: –Acute Medical inpatient bed days –Acute non-medical inpatient bed days –Emergency Department non-admitted events –Medical Outpatient events –… what about ARC?

16. SAS - Method What are our baseline utilisation rates for each service? What is the average cost of providing that service? How will demographic change affect demand for hospital services? What will be the cost of providing these services? What is a realistic target?

17. Locality X - Population Locality X EthnicityAge GroupDeprivation Baseline2013/142014/152015/162016/172017/18 Maori/PI 15-44 All 28,40428,85229,30829,77030,24030,718 45-74 12,10112,45612,82213,19813,58613,985 75+ 617652690730772816 Non Maori/PI 15-44 0-6 18,09718,03417,97117,90817,84517,783 7-10 19,65819,93320,21220,49420,78121,072 45-74 0-6 18,07218,21818,36618,51418,66418,815 7-10 16,33816,62416,91617,21217,51417,821 75-84 0-6 1,7501,8291,9121,9992,0902,184 7-10 2,7072,7452,7832,8222,8612,901 85+ 0-6 429453479505534564 7-10 1,0781,0921,1071,1221,1371,152

18. Locality X – Utilisation Locality X EthnicityAge GroupDeprivation ED Attendance not admitted AA/AC - MedicalAA/AC - OtherMedical OP Maori/PI 15-44 All 7975131125 45-7455456243695 75+531,440410697 Non Maori/PI 15-44 0-6433671124 7-107460102157 45-74 0-628160115423 7-1050306206650 75-84 0-634842331779 7-10511,131497970 85+ 0-6481,839621479 7-10421,674681518 Rates per 1,000 enrolled population

19. Locality X – Targets Baseline2013/142014/152015/162016/172017/18 Expected6,7636,8626,9647,0677,1737,281 Planned6,7636,7946,7556,7856,8146,771 Difference069209283359510 Cumulative0692785609191,429 Population growth is applied to baseline figure to estimate future volumes Utilisation rates are reduced by 20% across five years, to derive ‘planned’ volume targets

20. Locality X – FY2018

21. Locality X - Wash-Up ED Attendances (not admitted) FY2018 planned = $2,102,765 Actual ‘spend’ = $1,960,750 Total conserved resource = $142,015

22. So how are we tracking? After Q1 3 out of 4 Localities would owe us ! 4 th locality (favourable): 50% to LCP Leadership Group = $810,911 40% to CMDHB = $648,728 10% to PHO partners = $ 162,182 PHO A (80%) = $129,745 PHO B (20%) = $32,437

23. Region-Wide Governance Group DHB Clinical and Management/PHO Clinical Management/Iwi Locality Governance (Active Clinical Network x 2, Whaanau Ora Network x2, Community, x2 PCN?, Iwi) Locality Network (Virtual – No Entity or discrete funding) Local Service Change Local Performance Maintaining collegial relationships Active Clinical Network (Providing Local Clinical Governance Whaanau Locality Network (Providing Local Whaanau Ora Governance) Providing Services & Funding PCN Providers Services & Funding Whaanau Ora Services & Funding DHB Services & Funding Service Integration

24. Key Roles in Whaanau Ora in Localities Funded by CMDHB As Lead Agency Leading case management systems & tools Integrating WO and primary care service delivery Training & developing the workforce Monitoring performance & CQI processes Developing network Lead contracting and performance processes WO Network Lead Funded by Lead Agency with a m/ment fee Developing networks of NGO and social service providers; Linking WO practitioners and Whaanau to useful services; Developing solutions to service gaps in localities; Monitor locality performance and improve services WO Lead Agency WO Practitioner providers; Integrated WO service providers NGOs & other social services as part of networks Contracted to WO Network Lead WO Providers

25. The NHC Implementing a Lead Agency that delivers; Collaborates with four localities and the lead PHOs; (Mangere, Manukau & Otara) Builds Whānau Ora Networks in each Locality; Implements a transparent accountability and performance model; Ensures a high standard of WO service delivery and practise; –Training & development of WO Practitioners; –Standardised assessment & case management tools; Attracts other funders and agencies to support Whānau Ora service delivery; Operates a CQI process and collaborates with PHOs and DHBs to build more integrated and effective services to address social determinants based on evidence.

26. Locality Partnerships CMDHB to fund the NHC Lead Agency in line with Lead PHOs in Localities -NHC to establish Whaanau Ora system in priority localities -An open system Giving effect to the CMDHB agreement and building the system for: -Measuring impact & benefit consistently -Sharing the gain and incentivising services that work within and across localities Host PHOs Locality Service Investment WO Lead Agency WO Service Investment How investment decisions are made? How investment is shared?