Outline

• Update on localities establishment• System Integration Clinical Framework• Global Budget Setting• Whanau Ora Networks• Next Steps• Questions?

Locality General Manager’s

Lynda Irvine

Manukau

Sarah MarshallMangere/

Otara

Linda BryantEast

Geoff Smith

Franklin(30th Dec)

Kathy de Luc

Franklin(2nd Dec)

More Detail about the Work Programmes

The At Risk Individuals Programme is about

1. AT RISK INDIVIDUALS PROGRAMME

more planned, proactive care

AT RISK INDIVIDUALS PROGRAME

A number of programmes will be merged into the new ARI programme, including:

• CarePlus• High Risk Individuals• Chronic Care Management• CCM Depression• Self Management Education• Refugee Services• Diabetes Care Improvement Package 

1. Lots of programmes into one

1. AT RISK INDIVIDUALS PROGRAMME

AT RISK INDIVIDUALS PROGRAME

Risk

Stratification

Assessment Care Planning Funded

Interventions

Measuring

Predictive Risk Tool Common assessment tools

Consistent care planning system

Interventions clinicians can deliver or refer to in order to provide extra

support to patients

Evaluation and outcomes

measurement

Finalise predictive risk tool – agree

Develop and agree budgets – input vs. outcomes

Develop and agree consistent assessment tools

Develop roll out plan for e-shared care

Agree core set of interventions to be consistent district-wide – both value add General Practice and second tier services

Disease specific outcomes

Patient experience and health status outcomes

Acute demand outcomes

2. SERVICE REDESIGN

2. SERVICE REDESIGN

Evaluation FrameworkConfirm and begin implementation of an evaluation framework for Counties Manukau Health System Integration Programme Performance MetricsDevelop a dashboard for system integration that will collate key quality and performance data by LCP.

Learning System Clinical AuditLCPs undertake regular clinical audit programme to monitor improvementsin patient outcomes Quality•Quality improvement systems are established and developed in each LCP•Develop quality indicators for LCPs•Support LCPs to collect and analyse indicator data

3. QUALITY IMPROVEMENT IN LCPs

The Global Budget

Objectives

• Sharing accountability for whole of system outcomes

• Enhance and incentivise integrated clinical decision-making

• Better align service delivery with desired population health outcomes

• Enable improvement in capacity and capability

The Global Budget

Operational Budget

Health Services Programme Budget

Locality Primary and Community Health

Services

Shared Accountability Services (SAS)

Shared Accountability Services• From July 2013, we will share accountability for

reducing utilisation of:– Acute Medical inpatient bed days– Acute non-medical inpatient bed days– Emergency Department non-admitted events– Medical Outpatient events– … what about ARC?

SAS - Method• What are our baseline utilisation rates for each

service?• What is the average cost of providing that

service?• How will demographic change affect demand

for hospital services?• What will be the cost of providing these

services?• What is a realistic target?

Locality X - Population

Locality X

Ethnicity Age Group Deprivation Baseline 2013/14 2014/15 2015/16 2016/17 2017/18

Maori/PI

15-44

All

28,404 28,852 29,308 29,770 30,240 30,718

45-74 12,101 12,456 12,822 13,198 13,586 13,985

75+ 617 652 690 730 772 816

Non Maori/PI

15-440-6 18,097 18,034 17,971 17,908 17,845 17,783

7-10 19,658 19,933 20,212 20,494 20,781 21,072

45-740-6 18,072 18,218 18,366 18,514 18,664 18,815

7-10 16,338 16,624 16,916 17,212 17,514 17,821

75-840-6 1,750 1,829 1,912 1,999 2,090 2,184

7-10 2,707 2,745 2,783 2,822 2,861 2,901

85+0-6 429 453 479 505 534 564

7-10 1,078 1,092 1,107 1,122 1,137 1,152

Locality X – Utilisation

Locality X

Ethnicity Age Group Deprivation

ED Attendance not admitted AA/AC - Medical AA/AC - Other Medical OP

Maori/PI

15-44

All

79 75 131 125

45-74 55 456 243 695

75+ 53 1,440 410 697

Non Maori/PI

15-440-6 43 36 71 124

7-10 74 60 102 157

45-740-6 28 160 115 423

7-10 50 306 206 650

75-840-6 34 842 331 779

7-10 51 1,131 497 970

85+0-6 48 1,839 621 479

7-10 42 1,674 681 518

Rates per 1,000 enrolled population

Locality X – Targets

Baseline 2013/14 2014/15 2015/16 2016/17 2017/18

Expected 6,763 6,862 6,964 7,067 7,173 7,281

Planned 6,763 6,794 6,755 6,785 6,814 6,771

Difference 0 69 209 283 359 510

Cumulative 0 69 278 560 919 1,429

• Population growth is applied to baseline figure to estimate future volumes

• Utilisation rates are reduced by 20% across five years, to derive ‘planned’ volume targets

Locality X – FY2018

Locality X - Wash-Up

• ED Attendances (not admitted)

FY2018 planned = $2,102,765Actual ‘spend’ = $1,960,750

Total conserved resource = $142,015

So how are we tracking?

After Q1 3 out of 4 Localities would owe us !4th locality (favourable):

50% to LCP Leadership Group = $810,91140% to CMDHB = $648,728

10% to PHO partners = $ 162,182

PHO A (80%) = $129,745PHO B (20%) = $32,437

Region-Wide Governance GroupDHB Clinical and Management/PHO Clinical Management/Iwi

Locality Governance(Active Clinical Network x 2, Whaanau Ora Network

x2, Community, x2 PCN?, Iwi)

Locality Network(Virtual – No Entity or discrete

funding)Local Service Change

Local PerformanceMaintaining collegial relationships

Act

ive

Clin

ical

Net

wor

k(P

rovi

din

g L

oca

l Clin

ica

l G

ove

rna

nce

Whaana

u Loca

lity N

etwork

(Providing Local W

haanau Ora

Governance)

Providing Services & FundingPCN Providers Services &

FundingWhaanau Ora Services &

FundingDHB Services & Funding

Service Integration

Key Roles in Whaanau Ora in Localities

Funded by CMDHB As Lead Agency

• Leading case management systems & tools

• Integrating WO and primary care service delivery

• Training & developing the workforce

• Monitoring performance& CQI processes

• Developing network Lead contracting and performance processes

WO Network

Lead

Funded by Lead Agency with a

m/ment fee

• Developing networks of NGO and social service providers;

• Linking WO practitioners and Whaanau to useful services;

• Developing solutions to service gaps in localities;

• Monitor locality performance and improve services

WO LeadAgency

• WO Practitioner providers;

• Integrated WO service

• providers• NGOs & other

social services as part of networks

• Contracted to WO Network Lead

WO Providers

The NHC• Implementing a Lead Agency that delivers;• Collaborates with four localities and the lead PHOs;• (Mangere, Manukau & Otara)• Builds Whānau Ora Networks in each Locality;• Implements a transparent accountability and performance model;• Ensures a high standard of WO service delivery and practise;

– Training & development of WO Practitioners;– Standardised assessment & case management tools;

• Attracts other funders and agencies to support Whānau Ora service delivery;

• Operates a CQI process and collaborates with PHOs and DHBs to build more integrated and effective services to address social determinants based on evidence.

Locality PartnershipsCMDHB to fund the NHC Lead Agency in line with Lead PHOs in Localities-NHC to establish Whaanau Ora system in priority localities-An open systemGiving effect to the CMDHB agreement and building the system for:-Measuring impact & benefit consistently-Sharing the gain and incentivising services that work within and across localities

Host PHOs 

Locality Service

Investment

WO Lead Agency 

WO ServiceInvestment

How investmentdecisions are

made?

How investment is shared?