Diving under the Ice: The role of a health professional on an administrative funding team Rachel Tatham DIPOT, NZROT, BA Lead Professional Advisor Enable New Zealand, Palmerston North New Zealand to all key stakeholders of having a Health Abstract 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. Northland. 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 system. 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. product”. http://tutor2u.net/ 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 eligible. often unique to a specific customer and which represent additional facets to the organisation's basic offer. http://www.geodiswilson.com/en/ 2.1) 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. funding. This saving means that those who are eligible 2.3) 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 community 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 (www.disabilityfunding.co.nz). This 2.2) 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 website. information on a range of areas including Specialised Assessor prescription patterns, amount of spend of funding by individual or 2.4) 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 timeframes. 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. 2.5) Timely decisions made on applications (based on clinical reasoning supporting the Specialised Assessor There is a range of abilities and experience recommendation). 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 people. 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, process. 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. 2.7) 2.6) 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 2.8) 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 Conclusion 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 reasoning. 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. References Electronic media http://www.geodiswilson.com/en/ Tutor2u:Marketing Revision Resources Marketing AtoZ glossary (2004) http://tutor2u.net/business/marketing/glossary_ a.htm