National Enrolment Service (NES) Overview

October 2015 – June 2016

Introduction

IT – Key Enabler of more integrated health service provision.

What is the National Enrolment Service (NES) ?

How NES will help PHOs and General Practice

What your PHOs role is with NES implementation

NES Components

NES is Not……

IT Development - Key Enabler of More Integrated Primary Care Services The Primary Health Care sector is facing the twin

challenges of managing day to day acute demand and ensuring appropriate services are allocated to the management of high needs patients. The critical elements in overcoming this challenge is a continued focus on integration, clinically led performance improvement and the move toward more modern models of care.

IT infrastructure and development has a key role in supporting the adoption of more modern models of care and improving sector integration.

A number of IT initiatives are beginning to be implemented from 1 July 2015 , these are seen to be key enablers of integrated primary health services; providing accurate, timely and integrated health service provision.

The NES is a new IT initiative that will enable PHOs and General Practice to achieve more accurate, integrated, real time information on patient enrolment, eligibility, and identity.

What is the National Enrolment Service? (NES)

‘The NES will be a single source of truth for all national enrolment data.’

What this means……

• NES will provide the capability to support practices by assisting in patient identification.

• NES will integrate directly with the Practice Management Systems via a secure web-based service that links to Ministry of Health national identity and enrolment systems, providing relevant data for payment and reporting purposes.

• Enrolment and identity data will be updated in NES on a daily basis, allowing a real time view of national enrolment data.

How NES will help PHOs and General Practice

• A monthly ‘snapshot’ of the NES data will produce information on identity, and enrolment to allow for CBF payment allocation on a monthly basis.

• The current quarterly process is inefficient, processes are duplicated and prone to error.

………This leads to inaccuracies in the allocation of funding and creates a financial risk for practices and PHOs.

• NES will see the end of the inefficient retrospective quarterly submission of enrolment registers, allowing CBF funding to be more accurately allocated on a monthly basis to PHOs.

In Summary the Benefits of NES are:

• A centralised register with real time patient enrolment status enabling more timely payment calculation for enrolled patients,

• Single source of truth for enrolment data to ensure accuracy of Capitation Based Funding calculations,

• Validated NHI and up to date patient demographics, supporting accurate identification of patients and clinical safety,

• Validated addresses using e-SAM service, supporting accurate Geocoding and assignment of deprivation-based funding,

NES Benefits…..

• Processing and payment cycle reduced from 3 months to 1 month

• Amended enrolment business rules, due to real time enrolment and more timely funding of patients

• Web services integration with PMSs, creating a seamless experience for the user when interacting with national services

What your PHOs role is with NES implementation.

PHOs will need to provide comprehensive support to each of their general practices to assist with the preparation for NES over the six month transition period.

There are 5 Important steps for NES Set Up……

1) Data Cleansing up until 1 January 2016 - this includes;

- HPI Organisation IDs (both at PHO and General Practice level)

- missing or incorrect NHIs by practice

- Success and failure reports within NES

Note: PHOs will receive these reports securely. It will be encouraged that PHOs use these reports to support individual practices to clean their data before NES is used for payment and reporting purposes. Instructions will be sent along with these reports on what specific action needs to be undertaken for each.

What your PHOs role is with NES implementation.

NES Set up…..

2) All practices will need their PMS version to be upgraded with the capability to integrate with NES web services, including Enrolment and Identity. Practices will be notified by their software vendors when this is ready for installation, along with release notes.

3) Practices need to have access to Connected Health if they do not already. PHOs will need to undertake a stocktake of their practices to establish which are not signed up to Connected Health.

4) All Practices are required to have an HPI Organisation ID for NES. This will be checked during the HPI mapping process. In cases where new codes are required:

a) Requests for HPI Org Ids - HI_Provider@moh.govt.nz

b) If PHOs contract directly with Individual Providers - CBF payment separate to practices, a unique identifier within NES is required.

Health Provider Index Common Person Number (CPNs). These are assigned

to all health practitioners via Registration Authority (RA).

What your PHOs role is with NES Implementation.

NES Set up….

5) Users in a practice need to be set up with their own user name and password as well as the appropriate level of training.

Note : More information on this will be provided closer to the roll out.

It is strongly encouraged that PHOs ensure these 5 important steps are carried out over the next 6 months, to ensure an effective transition to NES.

As a PHO Champion, you will act as a consistent point of liaison and communication for this new service.

Health Identity.

• Practice PMS systems will now allow users to access and maintain patient information directly in the NHI system.

• National identifiers for patients and providers are fundamental to national solutions, including enrolment.

• High quality NHI and HPI data supports efficient and accurate payment to practices for population-funded activity.

• These will allow new efficiencies for practices – instead of having to look up or phone the contact centre, users will be able to directly search, update and add new patients in the NHI through their PMS.

• The roll-out of NES functionality will be carried out in tranches to ensure PHOs have enough time to adequately train staff so that all users feel comfortable before the active transition to NES.

• The Ministry will be releasing training material and providing support to PHOs on an ongoing basis during this phase.

Next steps

• The current quarterly process will continue until adequate testing has been done to confirm we have achieved specific quality targets for use and accuracy.

• We are beginning data cleansing and will plan production testing to validate NES functionality and workflow in parallel with current CBF register processing.

• Note that acceptance for final cutover/go-live July 2016 will be in conjunction with agreement from PSAAP and consultation with PHOs.