MHN Model of care

Drivers for Change

A Failing Public Private Partnership

• Exiting generation of business owners

• Emerging generation with different expectations

• 10-15 yrs of passive incremental disinvestment

• A growing gap between capacity and need

• Failed understanding of the nature of the PPP

• System too focused on building and maintaining Hospital services

• A primary care sector without a plan

The Journey

Current Model of Care

Patient Focused Future State

Sustainable Care

Patient Visit

Pre-Visit Prep

GP v. RN Visits

Appt at available time

Deferrals

Walk-in/Virtual

Planned v. Acute

% w/ pre-visit plan

% Pt contacted

% plans resulting in action

% Pt with PVS

# care plans produced

Pt satisfaction

System Initiated Contact

LEGEND

= General Practitioner (GP)

= Clinic Receptionist

= Paper Document

= Nursing Function (RN)= Computing Application

= Web Application

= External Partners & Suppliers

= Key Measures

= e-Mail = Push Process

= Electronic Flow

= Manual Flow

LeadTime

CycleTime

= Health Care Assistant (HCA)

= Clinical Pharmacist (CP)

PAC Staff

Initiate Visit & Escalation

PAC Staff

Review Patient Plan

PAC Staff

Schedule Pre-Work

PAC Staff

Review Results &

Update Plan

Reception

Plan Visit & Contact Patient

Reception

Schedule Visit & Required Resources

B Pac MMS

ESA

Web InfoPt Reference

Material

= Patient Access Centre Staff (PAC Staff)

GP & Team

Pre-Visit Preparation

Reception

Register Patient for

Visit

HCA or RN

Room Patient &

Pre-Consult Assessment

GP/RN/CP

Consult, Diagnosis, Care-plan

GP/RN/CP

Prepare Visit Summary &

Referrals

= Onsite Clinical Partners

RN/HCA/Partners

Perform Follow-up

CareGP/RN

Perform Final Review

Reception

Perform Admin

Check-out

GP & Team

Review, Communicate

Results & Update Care Plan

MedTech (centrally hosted)

Key Practi ce Measures

Patient Access Centre- Scheduling

- Patient Contact- Phone Consult & Triage

- Coordination of Internal/External Services- Recalls & Reminders- Secure Messaging

- Input Medical History

GP/RN/CP

Provide Virtual

Consult & Document

Common Practice Management Application

Patients

Txt2Remind

Schedule, Triage, Virtual Consult

Direct Clinic Contact

Patient Portal to MedTech

National Repository of Patient Health Records, Health Information Exchange,

and Transfer of Care

HealthLink

Hospitals

Paper Correspondence

DHB, ACC, So. Cross, NGO,

Private Practices

External Clinical Partners

Paper & PhoneCorrespondence

Demographics

Quality

Burdon

Satisfaction

Engaged

Access

Cost

Compliance

Everyone has Plan

Min. Data Set

Primary Care Clinic – Ideal State Map, 2015

% full pymt received

Volume of bad accts

% results received

% results communicated

% Pt follow-up

% results w/in TAT

% Pt with current plan

F2F v. Virtual Visits

% Pt e-access

Allied & Partners

Perform Mobile Outreach

Kiosk Check-in

Key Changes

• All onstage space shared between all clinical staff

• Standardised supplies/trolleys• More space – training and clinical services• MCAs - rooming• Clinical Pharmacist• Offstage space for all staff• Tripled the number of terminals• Reduced waiting space• Single phone system across all sites• Access across all sites to patient information• Online patient portal

Offstage for MCA

Offstage for

Nurses

Standard rooms

Offstage for Drs

Self management

areas

Reduced waiting

area

The PAC Tool box

• Multi site transparency – scheduling and real time availability of clinical staff

• General Enquires• Results + out bound campaigns• Care access

– 8-9am Dr triage– Virtual (nurse, pharmacist, Dr)– Planned virtual (nurse, pharmacist, Dr)– Face to face (nurse, pharmacist, Dr)

• DHB Clinical information – CWS• Other

Inbound Volumes• Higher level of calls earlier in the week• And also earlier in the day (8-10am)• Average 2,000 inbound calls per week

Demand

F2F

Virtual

Core Team

IFHC Team

F2F

Virtual

Demand

30 = 35 = 45

Others experience through implementing similar changes

• 9% decrease in F2F primary care consultations• 90% increase in secure messaging/e health• 12% increase in telephone consults• 8% increase in speciality referrals• 5% decrease in medical and surgical referrals• 29% decrease ED and urgent care• 11% decrease in avoidable hospitalisation• Cost neutral across the whole system

Phased development

Locality Planning• Creating and maintaining multi dimensional

views of geographical based grouping of populations, health burden and provider capability

• Redesigning service delivery models – SLaTs• Mapping future growth/decline • Stocktake of structures and systems• Planning the rebuild• Bridging the private equity of structures and

workforce with public service funding

Service Level Alliance Teams

• Defined outcomes • Ensure a continuum of care between primary and secondary

services • Prioritise people who are at risk, disengaged or who have

significant barriers to services • Whole of system approach

– Multidisciplinary• Integration and co-location where appropriate

New Service Models

• SLATs - Governed by the ALT• Clinician led – based on needs not history

– Diabetes, CVRM– Radiology– Growing Generations – 0 -17yrs– Primary and Community Nursing– Mental Health– Smoking Cessation – Older Persons

Key evaluation measures

1. To understand the patient’s experience of and satisfaction with accessing their health care via the IFHC model;

2. To understand the impact of working within an IFHC model for GPs, Practice Nurses and practice management staff in terms of professional and personal career progression and satisfaction;

3. To determine if application of the IFHC model has changed the pattern of secondary care acute demand from the IFHC enrolled population;

4. To determine whether application of the IFHC model has changed the pattern of service utilisation in primary care and in terms of referrals to secondary care services; and

5. To determine the commercial viability and sustainability of the IFHC model, as implemented by MHN, to manage future health service demand in primary and secondary care.

6. To review the health benefits of the IFHC model by examining a range of health measures