New Zealand Integrated CareIntegrated Care Study Tour May 2016

Fiona ThomsonCEO, General Practice New Zealand

Content Today

� Snapshot of New Zealand

� Overview of NZ Health System

� Integrated Care development

� Examples of Integrated Care� Examples of Integrated Care

� New paradigm

New Zealand

� Population 4,565,185

� GP Ratio approx 1:1600 (similar Nurses)

� 15% are 65+ years

� 74% NZ European, 14.9% Maori� 74% NZ European, 14.9% Maori

� 11.8% Asian, 7.4% Pacific Peoples

� Life Expectancy Male 79.5, Female 83.2

o Maori Male 73.0, Female 77.1

� Health spend NZ$15.6 billion (9.5% GDP)

� 13% adult population smokers

� 30% population overweight or obese

Health Quality and

Safety CommissionAtlas of Variation

Patient Experience of Care

20 DHBs

Beveridge

ModelPart charge primary care

ACCNational insurer

Part charge primary care

PHARMAC 20 DHBsGeographical commissioners of

health and social care

� 32 PHOs

� 1034 practices

� 800 Pharmacies

� Allied Health

� Aged Care

� NGOs

PHARMACNational purchaser

pharmaceuticals

HealthlineNational telehealth service

Connected

HealthNetwork and services

Who pays for what?

� Hospital level services – PBFF, no charge

o Some means testing for ancillary services

� General Practice – capitated subsidy, part charge

o Under 13 years – no charge GP and Pharmacy

o Adult charges range from $17.50 to $55.00

o Additional subsidy available for high need

� Pharmacy dispensing – FFS, part charge

o $5 per item, no charge if over 20 items p.a.

� Dental – FFS, no charge under 18 years

� Maternity – no charge, delivered by Midwives

Integrated Care Development

� 4 Historical Phases

o Pre 1990: limited coordination, poor integration, poor communication, Fee For Service (FFS) funding

o 1992 – 2000: GP Networks (meso-level primary care networks), clinical leadership, Immunisation, eMR, networks), clinical leadership, Immunisation, eMR, Referred Services mgmt, Acute Demand programmes, early capitation pilots

o 2001 – 2009: NZ Primary Health Care Strategy; PHOs –universality, population health, community governance, enrolment / capitation, health targets

o 2010+: “Better Sooner More Convenient” business cases, Integrated Family Health Centres, clinical leadership, Alliances, care pathways, Whānau Ora

Integrated Care Development

� 2013 PHO Services Agreement_Alliance Agreement

� Primary – Secondary integrationo pathways / eTransfer of Care / ePrescription / portals / eHealth Record

� Acute Demand Management risk stratification / At Risk Individual / packages of careo risk stratification / At Risk Individual / packages of care

� Primary Care Patient Experience of Care (HQSC)

� Health and social services integration

� Health Care Home / HC Community / HC Network

� Integrated Performance and Incentive Frameworko System Level Measures / Contributory Measures

Current Environment

• 2016_17 System Level Measures:

o Acute hospital bed days per capita

o ASH rates 0-4 year olds

o Patient experience of careo Patient experience of care

o Amenable mortality

o Youth access / utilisation youth appropriate services

o No. babies in smoke-free household at 6 weeks

• Alliance agrees Contributory Measures

New Zealand Health StrategyAchieving a better, more fit for purpose health system

All New Zealanders live well, stay well, get well, in a system that is people-

powered, provides services closer to home, is designed for value and high

performance, and works as one team in a smart system.

Roadmap of Actions to 2021

Whānau OraWhānau Ora encourages a shift in focus

from top-down delivery of services by

various agencies to address the problems

of individuals...

…to empowering whānau to identify their

aspirations to improve their lives, and

building their capacity to achieve their

goals.

Whanau Ora

� 7 agreed outcomes (1-25yrs):o Whānau are self-managing and empowered

leaders

o Whānau are leading healthy lifestyles

o Whānau are participating fully in societyo Whānau are participating fully in society

o Whanau and families are participating confidently in Te Ao Māori (the Māori world)

o Whānau and families are economically secure and successfully involved in wealth creation

o Whānau are cohesive, resilient and nurturing

o Whānau and families are responsible stewards of their living and natural environments

Primary Options Acute Care

� What is POAC?o Programme to safely manage acute demand in

the community

o Prevent unplanned hospital presentation and shorten length of stayshorten length of stay

o Direct access to investigations, care and treatment in the community to prevent unplanned ED presentation

o Requires coordination layer, agreed pathways and strong clinical governance

o Significant enabler of patient- focussed primary / secondary integration

o Evidence growth in acute demand has slowed

At Risk Individual (ARI)

New Paradigm – Social Investment

“Public agencies, which are full of good and capable people, often have little idea of whether their work makes a difference beyond meeting the immediate need.

Making a lasting difference and changing Making a lasting difference and changing lives is the whole point though. Good

intentions are absolutely necessary, but not sufficient.”

Min Bill English, Feb 2016

Social Investment Approach

• Seeks to improve the lives of New Zealanders by applying rigorous and evidence-based investment practices to social services.

• Clearer understanding of the indicators that • Clearer understanding of the indicators that are associated with poor outcomes, social sector and community organisations

• Identify where best to invest early rather than deal with problems after they have emerged

Key Risk Indicators

Predicted Outcomes

• 1% = 600 children per year

• Average group of 10:

o After high school seven would not have NCEA2 (74.6%).

o By 21 four will have been on a benefit long-term (40%).

o At 35 a quarter will have been in prison (24%).

o Poor life outcomes for each of these children plus substantial cost to the community and society as a whole.

o On average, each child in this group will cost taxpayers $320,000 by age 35 - some over $1million.

November 2016

November 2016