MHN
Model of care
Drivers for Change
A Failing Public Private Partnership
• Exiting generation of business owners
• Emerging generation with different expectations
• 10-15 yrs of passive incremental disinvestment
• A growing gap between capacity and need
• Failed understanding of the nature of the PPP
• System too focused on building and maintaining
Hospital services
• A primary care sector without a plan
The Journey
Current Model of Care
Patient Focused Future State
Demographics
Key Practice Measures
Quality
Burdon
Common Practice
Management
Application
Primary Care Clinic –
Ideal State Map, 2015
Satisfaction
Paper Correspondence
Engaged
Patients
Access
Cost
Schedule, Triage, Virtual Consult
DHB, ACC, So.
Cross, NGO,
Private Practices
Compliance
Perform Mobile
Outreach
% Pt with current plan
Patient Access Centre
F2F v. Virtual Visits
Txt2Remind
Everyone has Plan
Provide
Virtual
Consult &
Document
Allied &
Partners
- Scheduling
- Patient Contact
- Phone Consult & Triage
- Coordination of Internal/External Services
- Recalls & Reminders
- Secure Messaging
- Input Medical History
% Pt e-access
Direct Clinic Contact
National Repository of Patient Health
Records, Health Information Exchange,
and Transfer of Care
Min. Data Set
Hospitals
Paper & Phone
Correspondence
GP/RN/CP
HealthLink
Patient Portal to
MedTech
External Clinical
Partners
MedTech (centrally hosted)
Patient Visit
ESA
B Pac
System Initiated Contact
Review
Patient Plan
Initiate Visit
& Escalation
Schedule
Pre-Work
PAC Staff
PAC Staff
PAC Staff
Kiosk
Check-in
Pre-Visit Prep
Review
Results &
Update Plan
Plan Visit &
Contact
Patient
Schedule Visit
& Required
Resources
PAC Staff
Reception
Reception
Pre-Visit
Preparation
GP & Team
Register
Patient for
Visit
Reception
MMS
RN/HCA/
Partners
Web Info
Room
Patient &
Pre-Consult
Assessment
HCA or RN
Perform
Follow-up
Care
Perform
Final Review
GP/RN
Sustainable
Care
Pt Reference
Material
Consult,
Diagnosis,
Care-plan
Prepare Visit
Summary &
Referrals
Perform
Admin
Check-out
GP/RN/CP
GP/RN/CP
Reception
Review,
Communicate
Results & Update
Care Plan
GP & Team
GP v. RN Visits
% w/ pre-visit plan
% Pt with PVS
% full pymt received
% results received
Appt at available time
% Pt contacted
# care plans produced
Volume of bad accts
% results communicated
Deferrals
% plans resulting in action
Pt satisfaction
Walk-in/Virtual
% Pt follow-up
% results w/in TAT
Planned v. Acute
LEGEND
= Clinic Receptionist
= Health Care Assistant (HCA)
= General Practitioner (GP)
= Clinical Pharmacist (CP)
= Nursing Function (RN)
= Patient Access Centre Staff (PAC Staff)
= Onsite Clinical Partners
= Web Application
= e-Mail
= External Partners & Suppliers
= Electronic Flow
= Paper Document
= Key Measures
= Computing Application
= Push Process
= Manual Flow
Lead
Time
Cycle
Time
Key Changes
•
•
•
•
•
•
•
•
•
•
•
All onstage space shared between all clinical staff
Standardised supplies/trolleys
More space – training and clinical services
MCAs - rooming
Clinical Pharmacist
Offstage space for all staff
Tripled the number of terminals
Reduced waiting space
Single phone system across all sites
Access across all sites to patient information
Online patient portal
Standard
rooms
Offstage
for MCA
Self
management
areas
Offstage
for
Nurses
Reduced
waiting
area
Offstage
for Drs
The PAC Tool box
• Multi site transparency – scheduling and real time
availability of clinical staff
• General Enquires
• Results + out bound campaigns
• Care access
– 8-9am Dr triage
– Virtual (nurse, pharmacist, Dr)
– Planned virtual (nurse, pharmacist, Dr)
– Face to face (nurse, pharmacist, Dr)
• DHB Clinical information – CWS
• Other
Inbound Volumes
• Higher level of calls earlier in the week
• And also earlier in the day (8-10am)
• Average 2,000 inbound calls per week
F2F
Virtual
Demand
30 = 35 = 45
Others experience through implementing similar
changes
•
•
•
•
•
•
•
•
9% decrease in F2F primary care consultations
90% increase in secure messaging/e health
12% increase in telephone consults
8% increase in speciality referrals
5% decrease in medical and surgical referrals
29% decrease ED and urgent care
11% decrease in avoidable hospitalisation
Cost neutral across the whole system
Phased development
Locality Planning
• Creating and maintaining multi dimensional
views of geographical based grouping of
populations, health burden and provider
capability
• Redesigning service delivery models – SLaTs
• Mapping future growth/decline
• Stocktake of structures and systems
• Planning the rebuild
• Bridging the private equity of structures and
workforce with public service funding
Service Level Alliance Teams
• Defined outcomes
• Ensure a continuum of care between primary and secondary
services
• Prioritise people who are at risk, disengaged or who have
significant barriers to services
• Whole of system approach
– Multidisciplinary
• Integration and co-location where appropriate
New Service Models
• SLATs - Governed by the ALT
• Clinician led – based on needs not history
– Diabetes, CVRM
– Radiology
– Growing Generations – 0 -17yrs
– Primary and Community Nursing
– Mental Health
– Smoking Cessation
– Older Persons
Key evaluation measures
1. To understand the patient’s experience of and satisfaction with
accessing their health care via the IFHC model;
2. To understand the impact of working within an IFHC model for GPs,
Practice Nurses and practice management staff in terms of professional
and personal career progression and satisfaction;
3. To determine if application of the IFHC model has changed the pattern
of secondary care acute demand from the IFHC enrolled population;
4. To determine whether application of the IFHC model has changed the
pattern of service utilisation in primary care and in terms of referrals to
secondary care services; and
5. To determine the commercial viability and sustainability of the IFHC
model, as implemented by MHN, to manage future health service
demand in primary and secondary care.
6. To review the health benefits of the IFHC model by examining a range of
health measures