Outline
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Update on localities establishment
System Integration Clinical Framework
Global Budget Setting
Whanau Ora Networks
Next Steps
Questions?
Locality General Manager’s
Lynda
Irvine
Manukau
Linda
Bryant
East
Sarah
Marshall
Mangere/
Otara
Geoff
Smith
Franklin
Kathy
de Luc
Franklin
(30th Dec)
(2nd Dec)
More Detail about the Work Programmes
At Risk
Individuals
System
Redesign
Quality
Improvement
1.
AT RISK INDIVIDUALS PROGRAMME
The At Risk Individuals Programme
is about
more planned, proactive care
AT RISK INDIVIDUALS PROGRAME
1. Lots of programmes into one
A number of programmes will be merged into the new ARI programme,
including:
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CarePlus
High Risk Individuals
Chronic Care Management
CCM Depression
Self Management Education
Refugee Services
Diabetes Care Improvement Package
AT RISK INDIVIDUALS PROGRAME
AT RISK INDIVIDUALS PROGRAMME
1.
Risk
Assessment
Care Planning
Stratification
Predictive Risk Tool
Finalise predictive
risk tool – agree
Develop and agree
budgets – input vs.
outcomes
Funded
Measuring
Interventions
Common assessment
tools
Develop
and agree consistent
assessment tools
Consistent care
planning system
Develop roll out
plan for
e-shared care
Interventions clinicians
can deliver or refer to in
order to provide extra
support to patients
Agree core set of
interventions to be
consistent district-wide –
both value add General
Practice and second tier
services
Evaluation and
outcomes
measurement
Disease specific
outcomes
Patient experience
and health status
outcomes
Acute demand
outcomes
2.
2.
SERVICE REDESIGN
SERVICE REDESIGN
3. QUALITY IMPROVEMENT IN LCPs
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
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
Locality Primary and
Community Health
Services
Health Services
Programme Budget
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
Baseline
2013/14
2014/15
2015/16
2016/17
2017/18
28,404
28,852
29,308
29,770
30,240
30,718
12,101
12,456
12,822
13,198
13,586
13,985
617
652
690
730
772
816
0-6
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
0-6
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
0-6
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
0-6
429
453
479
505
534
564
7-10
1,078
1,092
1,107
1,122
1,137
1,152
Deprivation
15-44
Maori/PI 45-74
All
75+
15-44
45-74
Non
Maori/PI
75-84
85+
Locality X – Utilisation
Locality X
Ethnicity Age Group
Deprivation
15-44
Maori/PI 45-74
45-74
Non
Maori/PI
75-84
85+
AA/AC - Other
Medical OP
79
75
131
125
55
456
243
695
53
1,440
410
697
0-6
43
36
71
124
7-10
74
60
102
157
0-6
28
160
115
423
7-10
50
306
206
650
0-6
34
842
331
779
7-10
51
1,131
497
970
0-6
48
1,839
621
479
7-10
42
1,674
681
518
All
75+
15-44
ED Attendance
AA/AC - Medical
not admitted
Rates per 1,000 enrolled population
Locality X – Targets
• 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
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
Locality X – FY2018
Locality X - SAS Performance
ED Attendances (not admitted)
7,000
6,000
5,000
4,000
3,000
2,000
1,000
0
July
August
September
October
November
December
Planned
January
Actual
February
March
April
May
June
Locality X - Wash-Up
• ED Attendances (not admitted)
FY2018 planned = $2,102,765
Actual ‘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 = $810,911
40% to CMDHB = $648,728
10% to PHO partners = $ 162,182
PHO A (80%) = $129,745
PHO B (20%) = $32,437
Region-Wide Governance Group
DHB Clinical and Management/PHO Clinical Management/Iwi
Locality Governance
Locality Network
(Providing Local Clinical
Governance
Providing Services & Funding
DHB Services & Funding
PCN Providers Services &
Funding
Service Integration
Whaanau Ora Services &
Funding
Whaanau Locality
Network
(Virtual – No Entity or discrete
funding)
Local Service Change
Local Performance
Maintaining collegial relationships
(Providing Local Whaanau Ora
Governance)
Active Clinical Network
(Active Clinical Network x 2, Whaanau Ora Network
x2, Community, x2 PCN?, Iwi)
Key Roles in Whaanau Ora in Localities
Funded by Lead
Agency with a
m/ment fee
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 Lead
Agency
WO
Network
Lead
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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
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WO Practitioner
providers;
Integrated WO
service
providers
NGOs & other social
services as part of
networks
Contracted to WO
Network Lead
WO
Providers
The NHC
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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 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
How investment
decisions are
made?
Host PHOs
Locality
Service
Investment
WO Lead Agency
WO Service
Investment
How investment
is shared?