The role of a health professional on an administrative funding

Diving under the Ice:
The role of a health professional on an
administrative funding team
Rachel Tatham
Lead Professional Advisor
Enable New Zealand, Palmerston North New Zealand
to all key stakeholders of having a Health
Enable New Zealand administers Ministry of
Professional on the funding administration team
will be delved into during this session.
Health (Government) funding for equipment and
Housing modifications for people with
Key words
disabilities. The Policy and Professional Advice
role at Enable New Zealand is a unique role, in
providing good outcomes for people applying
Policy, funding, Professional Advisor, disabled
for Ministry of Health funding. This role is
person, Health Professional
perceived as a person who can say yes or no to
1. Introduction
funding, but this is just the tip of the iceberg.
Diving down beneath the surface this specialist
Enable New Zealand is contracted to provide
role will be detailed and discussed, regarding
and deliver a range of services to older people
the positive way it can make a difference to
and disabled people in New Zealand. These
health professionals and clients accessing
services are contracted by the Ministry of
Ministry of Health funding, while still working
Health (the Ministry of Health organises the
within a criteria framework and managed
funding and purchasing of health and disability
funding. Benefits are also significant to the
support services on behalf of the Crown), ACC
Ministry of Health. Examples of the added value
(NZ Accident Compensation Corporation) and
some District Health Boards (DHBs). DHBS
Auckland. Another provider accessable, is
provide or fund health and disability services in
contracted for a similar role in Auckland and
their district.
These contracted services include Disability
information services to all of New Zealand, a
The Ministry of Health have a set criterion for
local area Support Needs Assessment and Copeople with disabilities to access this funding.
ordination Service, administration of spectacle
Enable New Zealand administers the funding
subsidies for children, hearing aid subsidies,
allocated, based on this set criteria and priority
Equipment and Housing modifications
guidelines. This is a needs based funding
provision, a Seating, Wheelchair and
Positioning Outreach Service, maintaining a
national database of Accredited Specialised
To access this Ministry of Heath funding a
Assessors, provision of short term equipment
disabled person applies for funding via their
services to some District Heath boards,
relevant Health Professional (a registered
management of Housing modifications for ACC
Specialised Assessor). Specialised Assessors
throughout New Zealand and ACC equipment
include Physiotherapists, Occupational
provision to areas in New Zealand.
Therapists, Audiologists, Optometrists, Speech
Language Therapists.
The contracted service that will be discussed in
this paper is the administering funding for
The Specialised Assessor determines if the
Equipment, Vehicle purchase and modifications
person is eligible for Ministry of Heath funding,
and Housing Modifications on behalf of the
and submits and application to Enable New
Ministry of Health. This contract includes the
Zealand for consideration.
provision of an ongoing maintenance service of
Over a year Enable New Zealand receives
the funded equipment and the management of
approximately 55 000 applications for
a reissue store to recycle equipment where
Equipment, Vehicles and Housing modifications
possible. This service covers south of
for disabled people who want to access Ministry
of Heath Funding. Enable New Zealand
2. The
Professional Advisor Role
administers approximately NZ$45 Million on
behalf of the Ministry Health for this contract.
The Professional Advisors are a group of
Enable New Zealand have a large number of
Health Professionals who have various roles in
administration staff to review, determine
assisting in the administration of funding for
eligibility and cost effectiveness, prioritise
Enable New Zealand (on behalf of the Ministry
(based on Ministry of Heath Criteria) and
of Health).
process these applications.
As well as administration staff there a team of
Policy and Professional Advisors. This team
includes a range of skilled allied health
professionals (called Professional Advisors)
and Housing Advisors who provide advice to
Literature searches were completed to discover
if this role has been researched and justified.
However limited information was ascertained,
which demonstrates it as a unique and/or
unexplored role in a funding team.
the internal business units at Enable New
Zealand, Specialised Assessors, disabled
people and the Ministry of Health. The role of
the Professional Advisors in this team will be
further elaborated on, and discussed in terms of
how from my observations, involvement,
feedback and statistical recording they add
value to an administration funding team, the
Specialised Assessors submitting applications,
the person with the disability and the contract
provider the Ministry of Health.
In the tip of the iceberg (the visible bit)
Professional Advisors have been perceived as
gate keepers of the funding. They are the
people who said that an application was not
eligible and/or cost effective to meet the
Ministry of Health funding criteria. This created
a perception of a bureaucratic role by the
disabled person and the Specialised Assessors
who were accessing Ministry of Heath funding.
This role could be performed in this context
however over the years has evolved into a
dynamic and exciting position with a range of
possibilities that are only limited by the person’s
and above those representing the “core
skills and experience.
The role can be lot more than just the
determining if a disabled person is eligible for
funding. There is significant added value
underneath the surface of this role that requires
further elaboration with examples.
The basic offer or core product in this role is the
review of applications submitted by the
Added value has a number of definitions: Many
Specialised Assessor and determining if the
of the definitions reviewed were related to
disabled person is eligible for the Ministry of
financial gains however added value in Health
Heath funding or not.
is significantly more than financial gains.
The following is additional facets and features
Two definitions that define added value in terms
of the role that assist in provision of quality
that reflect the discussion in this paper are;
services for disabled people. This ensures the
funding is fairly and equitably accessed and
distributed to the disabled people who are
Added Value Services: Services which are
often unique to a specific customer and which
represent additional facets to the organisation's
basic offer.
Savings for the Ministry of Health
resulting in funding being able to be
Added value refers to the increase in worth of a
used for those in highest need.
product or service as a result of a particular
activity. In the context of marketing, the added
The Professional Advisory team has started to
value is provided by features and benefits over
record savings and added value in other terms
to demonstrate the significance of having them
Enable New Zealand Professional Advisors
in a funding administration team.
provide ongoing feedback to the Ministry of
Health on issues identified with the Ministry of
Two months of statistics (May and June 2010)
Health criteria, areas of inconsistencies, high
have been recorded and in this two month
cost requests, demand management ideas and
period approximately $600,000 was saved as a
policy assistance when requested.
result of involvement by the Professional
Advisors. This was predominately because
The Ministry of Health have a number of
alternative equipment / solutions were found,
initiatives to improve the Equipment and
while the disabled person’s needs were still
Modification services for disabled people and
met. In some cases a disabled person may
the Professional Advisors are actively involved
have not been eligible for Ministry of Health
in these initiatives.
This saving means that those who are eligible
Provision of information and
get the equipment or service provision and
transparency to the disabled person,
more disabled people have access to funding.
Whanau (family) and disability
More cost effective solutions, with the same
outcome for a disabled person provide
Information on the criteria and processes
financial benefits to the Ministry of Health and
including funding timeframes are all available
ensure funding is spent fairly and equitably.
on a website for anyone to review and
consider ( This
Provision of advice to the Ministry of
provides the disabled person with the
Health for policy development and
opportunity to decide if they may meet criteria
service improvements
or if they want to wait for the anticipated delay
before their application is processed. The
Professional Advisor is available by phone to
on own practice. These generic decisions are
discuss any queries with them if they want
in the very start of a process of being tested in
clarification on policy and is responsible for
research. Audits of applications and data
the ongoing updating the disability funding
mining provide Enable New Zealand with
information on a range of areas including
Specialised Assessor prescription patterns,
amount of spend of funding by individual or
Provision of a peer review of
groups of Specialised Assessors, solutions
applications including if required,
proposed, revisiting needs within minimal
auditing of applications and providing
feedback to relevant people where it has
been identified there is an ongoing issue
with the performance of an individual or
group of Specialised Assessors.
Timely decisions made on applications
(based on clinical reasoning
supporting the Specialised Assessor
There is a range of abilities and experience
among Specialised Assessors in the health
The information contained in the application
sector from the new graduate to an
from the Specialised Assessor needs to
experienced practitioner. Enable New Zealand
establish clearly that the product or service
receives application for funding from all these
requested meets the Ministry of Health
criteria. The Professional Advisor reviews all
this information, aiming to make a decision
Enable New Zealand Professional Advisors
based on clinical reasoning. If unable to make
have made some generic decisions on what is
a decision, additional information is sought
best practice for standards of applications and
from the Specialised Assessor to support
rationale required to support solutions based
approval of the application. Approximately
on other Specialised Assessor practice and
50% of applications that come to Professional
Advisors to review are turned around on the
In the wheelchair, seating and 24 Hour
same day back to the processing team to
positioning outreach service the client,
whanau, family, significant caregivers,
This streamlines application processing and
technician, Specialised Assessor and a
therefore reduces Specialised Assessor time by
Professional Advisor meet to discuss the
having to respond to a number of queries that
current situation and to explore options that
may not have been required.
would meet the client need while adhering to
When an application is not rationalised or
the Ministry of Health guidelines. Contact is
justified as a solution that must be provided to
made with the Enable New Zealand stores
meet the identified disability needs, the
regarding the possibility of reissue product,
Professional Advisor requests additional
and where necessary, contact is made with
information to support the application, to
suppliers. In many cases this process is
establish if it may meet Ministry of Health
begun or even completed at the outreach
criteria. The Professional Advisor has the skills
appointment. Approval for funding of the
to ascertain what information is required for the
agreed solution is assured. This provides a
application to meet the Ministry of Health
responsive, needs based service supporting
criteria but also has the skills to clearly identify
the disabled person and Specialised Assessor
why the application doesn’t meet criteria, which
while still working within the framework of
may include guidance on where else funding
managed funding and eligibility criteria.
may be accessed.
Hands on supporting role to
Available, easily accessible and highly
responsive to service users
Specialised Assessors with disabled
people with identified complex needs
The Professional Advisory team attend national
in particular in high spend and highly
conferences, visit Specialised Assessors
technical areas
regularly and have well developed networks
throughout the country. They are easily
accessible by phone and email and value fast
Continuous growth of a knowledge base
responses to queries, therefore are accessed
of what options have been considered
by Specialised Assessor to provide advice
and approved to meet similar needs in
before they submit applications regarding
the past is an invaluable resource to
eligibility, solutions, options, expectations
Specialised Assessors accessing
around interagency collaboration and/or policy.
funding for their disabled clients.
This guides the Specialised Assessor in the
information required and options to be
considered before an application is required.
As an outcome there is better understanding of
the Ministry of Health criteria and correct
interpretation and application of these criteria.
Diving down beneath the surface, a specialist
role of a health professional on an
administrative funding team offers many
positive gains for the health professionals
The Professional Advisory team have all been
Specialised Assessors in the past so have an
understanding of the issues that they are faced
when accessing Ministry of Health funding for
their disabled clients, and also have established
networks within the health sector. It is
reassuring for the Specialised Assessor to
discuss more complex issues with another
health professional who clearly understands the
Ministry of Health eligibility criteria for
equipment and modifications but also has
clinical knowledge and the skill of clinical
submitting applications for the Ministry of Health
funding and the disabled person accessing the
Ministry of Health funding for their equipment,
vehicles and/or housing modifications. There
are significant benefits and challenges in the
Professional Advisor role, and it is not just a
gate keeper to the funding. The overall benefit
is ensuring the Crown money is spent fairly and
equitably, while ensuring it is able to meet the
needs of the disabled person. The position has
evolved into more an advisor role, enabling
Specialised Assessor to become confident in
seeking information and gaining knowledge and
support for their applications. It has developed
into a challenging and growing role which adds
value to many facets of the funding
administration community.
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