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Outline. Update on localities establishment System Integration Clinical Framework Global Budget Setting Whanau Ora Networks Next Steps Questions?. Locality General Manager’s. Kathy de Luc Franklin (2 nd Dec). Geoff Smith Franklin (30 th Dec). Lynda Irvine Manukau. Linda Bryant - PowerPoint PPT Presentation
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Outline
• Update on localities establishment• System Integration Clinical Framework• Global Budget Setting• Whanau Ora Networks• Next Steps• Questions?
Locality General Manager’s
Lynda Irvine
Manukau
Sarah MarshallMangere/
Otara
Linda BryantEast
Geoff Smith
Franklin(30th Dec)
Kathy de Luc
Franklin(2nd Dec)
More Detail about the Work Programmes
The At Risk Individuals Programme is about
1. AT RISK INDIVIDUALS PROGRAMME
more planned, proactive care
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
1. AT RISK INDIVIDUALS PROGRAMME
AT RISK INDIVIDUALS PROGRAME
Risk
Stratification
Assessment Care Planning Funded
Interventions
Measuring
Predictive Risk Tool Common 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
2. SERVICE REDESIGN
2. SERVICE REDESIGN
Evaluation FrameworkConfirm and begin implementation of an evaluation framework for Counties Manukau Health System Integration Programme Performance MetricsDevelop a dashboard for system integration that will collate key quality and performance data by LCP.
Learning System Clinical AuditLCPs undertake regular clinical audit programme to monitor improvementsin 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
The Global Budget
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
The Global Budget
Operational Budget
Health Services Programme Budget
Locality Primary and Community Health
Services
Shared Accountability Services (SAS)
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?
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?
Locality X - Population
Locality X
Ethnicity Age Group Deprivation Baseline 2013/14 2014/15 2015/16 2016/17 2017/18
Maori/PI
15-44
All
28,404 28,852 29,308 29,770 30,240 30,718
45-74 12,101 12,456 12,822 13,198 13,586 13,985
75+ 617 652 690 730 772 816
Non Maori/PI
15-440-6 18,097 18,034 17,971 17,908 17,845 17,783
7-10 19,658 19,933 20,212 20,494 20,781 21,072
45-740-6 18,072 18,218 18,366 18,514 18,664 18,815
7-10 16,338 16,624 16,916 17,212 17,514 17,821
75-840-6 1,750 1,829 1,912 1,999 2,090 2,184
7-10 2,707 2,745 2,783 2,822 2,861 2,901
85+0-6 429 453 479 505 534 564
7-10 1,078 1,092 1,107 1,122 1,137 1,152
Locality X – Utilisation
Locality X
Ethnicity Age Group Deprivation
ED Attendance not admitted AA/AC - Medical AA/AC - Other Medical OP
Maori/PI
15-44
All
79 75 131 125
45-74 55 456 243 695
75+ 53 1,440 410 697
Non Maori/PI
15-440-6 43 36 71 124
7-10 74 60 102 157
45-740-6 28 160 115 423
7-10 50 306 206 650
75-840-6 34 842 331 779
7-10 51 1,131 497 970
85+0-6 48 1,839 621 479
7-10 42 1,674 681 518
Rates per 1,000 enrolled population
Locality X – Targets
Baseline 2013/14 2014/15 2015/16 2016/17 2017/18
Expected 6,763 6,862 6,964 7,067 7,173 7,281
Planned 6,763 6,794 6,755 6,785 6,814 6,771
Difference 0 69 209 283 359 510
Cumulative 0 69 278 560 919 1,429
• 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
Locality X – FY2018
Locality X - Wash-Up
• ED Attendances (not admitted)
FY2018 planned = $2,102,765Actual ‘spend’ = $1,960,750
Total conserved resource = $142,015
So how are we tracking?
After Q1 3 out of 4 Localities would owe us !4th locality (favourable):
50% to LCP Leadership Group = $810,91140% to CMDHB = $648,728
10% to PHO partners = $ 162,182
PHO A (80%) = $129,745PHO B (20%) = $32,437
Region-Wide Governance GroupDHB 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 PerformanceMaintaining collegial relationships
Act
ive
Clin
ical
Net
wor
k(P
rovi
din
g L
oca
l Clin
ica
l G
ove
rna
nce
Whaana
u Loca
lity N
etwork
(Providing Local W
haanau Ora
Governance)
Providing Services & FundingPCN Providers Services &
FundingWhaanau Ora Services &
FundingDHB Services & Funding
Service Integration
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 LeadAgency
• WO Practitioner providers;
• Integrated WO service
• providers• NGOs & other
social services as part of networks
• Contracted to WO Network Lead
WO Providers
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.
Locality PartnershipsCMDHB to fund the NHC Lead Agency in line with Lead PHOs in Localities-NHC to establish Whaanau Ora system in priority localities-An open systemGiving 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 ServiceInvestment
How investmentdecisions are
made?
How investment is shared?