Beress Brooks, ABF/M - Acivity Based Funding and Management in WA and the National Health Reform
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Transcript of Beress Brooks, ABF/M - Acivity Based Funding and Management in WA and the National Health Reform
Activity Based Funding and Management in Western Australia and the National Health Reform
improving care – managing resources – delivering quality
Beress Brooks, Director, ABF/M
Slide 2
Today’s presentation
Principles of the WA ABF Model
National Health Reform - ABF with the State as System Manager
Funding Model for Service Level Agreements in 2012/13
WAUs – where to from here
Slide 3
Activity Based Funding and Management in WA Learning from past experience
Attempt to introduce casemix in 1990s – but lack of broad buy in
Introduced in July 2010 with clear purpose: “to improve safety and quality of care at an efficient price”
Recruited diverse program team: Policy and Strategy Systems and processes Operating model Performance Management Change Management and Communications
Slide 4
Vision for WA ABF/ABM
ABF is the management tool that supports ABM to enhance public accountability and drive technical efficiency in the delivery of health services by: Capturing consistent information on activity and cost of delivery; Creating an explicit relationship between funds allocated and services provided; Strengthening management’s focus on outputs, outcomes, quality and safety; Managing variation in costs and practices to improve efficiency and effectiveness; and Providing mechanisms to reward good practice and support quality and safety initiatives.
Slide 5
Focus on Safety and QualityThe principal aim of ABF / ABM is to deliver safe care of the highest quality in a timely manner, to citizens and patients who need it, at an agreed price.
Maintain / improve
S&Q under ABF/ABM
• Reduce variation• Facilitate improvement• Learn from mistakes• Reward success• Provide incentives /
disincentives• Remove perverse
incentives• Enable long term planning
and investments by health services and AHS
• Avoid gaming and cost shifting
1. Reduce harm
2. Improve technical and allocative efficiency
3. Maximise value
HEALTH CONSUMERS
COUNCIL BOARD
CHAIRS OF CONSUMER ADVISORY COUNCILS
CLINICAL CODING
COORDINATORS, HEALTH
INFORMATION MANAGERSAND WARD CLERKS
HEALTH NETWORKS
ALLIED HEALTH COUNCIL CHAIRS
STATE EXECUTIVE
DIRECTORS OF NURSING
MEDICAL DIRECTORS
FORUM
ABF/ABM CLINICAL COSTING
NETWORK
ABF/ABM CLINICAL
ADVISORY GROUP
NATIONAL HEALTH REFORM
IMPLEMENTATION STEERING GROUP
STATE HEALTH EXECUTIVE
FORUM
OPERATIONS REVIEW
COMMITTEE
MODEL OF CARE IMPLEMENTATION
REVIEW COMMITTEE
FINANCE AND PERFORMANCE
WORKING GROUP
INSTITUTE FOR HEALTH
LEADERSHIP
AREA HEALTH EXECUTIVE
COMMITTEES
HOSPITAL/SITE EXECUTIVE COMMITTEE
ABF/ABM IMPLEMENTATION STAKEHOLDERS
DEPARTMENT OF HEALTH
DIVISIONS
PERFORMANCE, ACTIVITY AND
QUALITY
WORKFORCE
HEALTH INFORMATION
NETWORK
HEALTH CORPORATE
NETWORK
INNOVATION AND HEALTH SYSTEM
REFORM
RESOURCE, STRATEGY AND
INFRASTRUCTURE
STATE HEALTH INFRASTRUCTURE
PLAN
SAFETY AND QUALITY
EXECUTIVE ADVISORY
COMMITTEE
CSO
NETWORK
improving care I managing resources I delivering quality
ABF/ABM BUSINESS
IMPROVEMENT PROJECT CONTROL
GROUP
Broad engagement of corporate and clinical stakeholders from outset of program
Slide 7
Performance Management Framework (PMF)
The PMF 2012-13 establishes: Performance reporting, monitoring, evaluation, management and
intervention The role of Outcome Measures as Key Performance Indicators The role of Health Service Measures as supporting information
It includes: 23 Key Performance Indicators, targets and thresholds 34 Health Service Measures and targets
It aligns with: The new National Health Performance Authority, Performance and
Accountability Framework The Australian Government MyHosptials website The ACSQHC national core hospital-level outcome indicators
Slide 8
ABF/ABM Management Framework
Integrated management approach to plan, manage, deliver and control services,
activity and financial resources to ensure delivery of safe high quality health services to the
WA community.
Models of Care
(Best practice health care and services across entire continuum)
Safe High Quality and Efficient Health Services across WA
14
Clinical Services Planning
(WA Health Clinical Services Framework 2010-2020)
2
Funding and Costing
(Output based methodology)
3
ABF/ABM framework effectively integrates the key components of health service planning and delivery
Slide 9
National ABF Independent Hospital Pricing Authority (IHPA)
Recommends scope of services Develops national classifications for ABF Develops activity weights and funding model Sets the National Efficient Price (NEP) Uses hospital based costing information (NHCDC)
Phased introduction over 2012/13 & 2013/14 Commonwealth funding a mix of block funding
and ABF
Slide 10
The National Efficient Price (NEP)
The NEP has two main roles Determining Commonwealth funding to States
and Territories for Public Hospital Services Adjusted to reflect other revenue to States and
Territories e.g. Health funds, Commonwealth funding streams
Providing a price signal about the cost of providing public hospital services and promotes transparency
Slide 11
National Health Reform will affect:
How information is gathered and categorised Nationally agreed standards and performance
indicators. What information about WA’s public health
services is made available to the public How hospitals and primary care work together in
WA
Commonwealth funding for Public Hospital Services will become more explicit
Slide 12
National ABF and Western Australia
Builds on the WA implementation of ABF/M for public hospital services
Improve consistency and transparency of national classification and costing
Increased Commonwealth funding for efficient growth in services from 2014/15
State as manager of WA public hospital services
Slide 13
State is the Health “System Manager”
System wide direction and policy Performance management Setting activity levels and pricing Dominant funder of public hospital services Incorporate national ABF in State Policy
e.g. nWAUs, technical modeling, activity collections, reporting, national classifications, NHCDC and more.
Slide 14
System Manager - Setting Activity Levels
The Clinical Services Framework (CSF) and the underlying demand modelling information is the WA Health blueprint for service delivery
The CSF is influenced by
Area Health Service clinical planning
Infrastructure development
Demand modelling
Models of Care and service delivery options e.g. community based services
Demographic information
Slide 15
State as System Manager ABF Application of Service Delivery
The CSF is the service delivery plan that WA Health takes to Government in its budget request
Subject to the outcome of the budget negotiations the activity and associated funding is allocated to Health Services by the ABF operating model
Slide 16
State as System ManagerSafety and Quality under ABF/ABM
Two main areas of focus
Improving care by reducing adverse events
Improving care by reducing unwanted variation
Slide 17
Adverse EventsAdverse events can result in an increase in the level of care, prolonged hospitalisation and/or disability at the time of discharge from medical care
The impact of adverse events:
It is estimated that at least 50% of adverse events are preventable*
Local modelling suggests that the cost attributable to adverse events was more than $100M in 2008-09**
On average adverse events increase length of stay by seven to eight days and cost approximately $8000 extra per admission^
Preventable
Slide 18
Cost $
Low BoundaryThreshold
CE Avg High BoundaryThreshold
NOS
Adverse Event Cost Signature
Cost signature of typical (non-AE) episode
Poor quality and unsafe care often results in adverse events (AEs). In addition to the unnecessary harm to patients, carers and families, AEs impart considerable burden on health care resources.
Source: Office of Safety and Quality in Healthcare, PAQ, WA Health
The Quality Incentive Program (QuIP) provides funds to improve the system performance on long stay patients and adverse events.
Slide 19
Funding Model for 2012/13WA State Price in a National ABF Model
Developing State Price IHPA will determine
National ‘efficient’ price for Commonwealth contribution to Health Services (LHN’s)
DoH WA will determine State prices based on National Model to develop Service Agreement with Health Services
Service Agreement
Slide 20
National ABF Inpatient Model Features
LOS boundary points (L3;H3)
Short Stay outliers, Inlier, Long Stay Outlier
ICU adjustment Indigenous Patient Loading Outer Regional/Remote
Patient Loading Specialised Paediatric Site
Loading
Similar to WA ABF model in 11/12
Similar concept to WA some method differences
In WA ABF model No direct loading in WA
model WA has regional cost
loadings Included in WA ABF
11/12 – peer groups
Slide 21
Health Services – Service Level Agreement
Activity level Service Agreement Inpatient (WAUs)
Emergency Department (WAUs)
Outpatient Clinics (WAUs) Block Grants
TT&R Small Rural & Remote Hospitals Non admitted mental health Non admitted community based
services Other non activity based services
Slide 22
WAUs - where to from here
Slide 23
Local Hospital Networks
In WA the terminology will be Heath Services (HS)
•Child and Adolescent HS
•North Metropolitan HS
•South Metropolitan HS
•Northern and Remote Country HS
•Southern Country HS
Slide 24
Does One Size Fit All?
WA recognises the following in data that is not in the proposed national ABF model for 2012/13
•Rural cost differences – distinct by region
•Differences in the cost of providing public hospital services for patients 100KM from Perth compared to 2,000 KM
•Equity for Health Services – five Health Services in WA with population ranging from 225,000 to 950,000
•Peer groups
Slide 25
WA View of Priority National Developments
Classification Sub Acute Mental Health Emergency Department Non Admitted – hospital clinics and community
Costing Standards Teaching, Training and Research Medical Costs
Funding Model Patient attributes to provide equity to States and LHNs
Slide 26
Focus of ABF/M development work in WA
Develop/enhance processes, people or tools so we:
CollectCountCodeClassifyCost
Understand our business
Fund services appropriately
Improve service efficiency
Improve safety and quality
Make more informed decisions
Negotiate for Commonwealth Funds
Slide 27
WA ABF Infrastructure Development
Non Admitted Services – focus on consistency and comprehensive collection of activity
Sub Acute – significant work program to collect relevant information for sub acute classifications in designated units
Policies and procedures – Admissions, Readmissions, Discharges and Transfers
Clinical Documentation – Clinical Casemix Handbook for clinical staff
Slide 28
Clinical Costing Development in WA
Trendstar Clinical Costing system being replaced by a statewide implementation of PowerHealth Solutions PPM2
ABM Business Improvement Program
Slide 29
ABF/M Business Improvement Program
Compliance with National Standards Audit of quality and consistency of patient
costing information Review of utilisation of patient costing
information in managing the business Change management focus on clinical and
business staff Focus on round 16 (2011/12) NHCDC costing
collection
Slide 30
Resources & supports available
http://www.health.wa.gov.au/activity/home