Health Care Sydney North PHN AGM Dr Walid Jammal MBBS FRACGP DCH - PowerPoint PPT Presentation

The Future of Primary Health Care Sydney North PHN AGM Dr Walid Jammal MBBS FRACGP DCH MHL November 2016

An Environment of Reviews • Primary Health Care Review • MBS Review - GP services • Health Insurance Review • Practice Incentives Program • From “volume to value” • Value-proportional to quality and inversely proportional to cost

What are we going to do?

So where are we heading? Lewis Carroll - Alice In Wonderland (1865) 10

The Triple and Quadruple Aim of Health Care 11

The ten building blocks of high performing primary care 10 Template of the future 8 9 Prompt Comprehensive-ness and care Access to care coordination 5 6 7 Patient-team Population Continuity of partnership management care 3 1 2 4 Empanelment Engaged Data-driven Team-based leadership improvement care Bodenheimer et al, “The 10 Building Blocks if High Performing Primary Care” Annals Family Medicine Vol 12 2014

PATIENT FAMILY COMPREHENSIVE CENTRED CHANGES MEASURES CHANGES MEASURES Multi- Data registries • • • Patient • PREM disciplinary • Quality advisory panels • Patient care-top of improvement • Cultural comments license • “defect lists” competency • Chronic • Focus groups disease • Holistic care COORDINATED CONTINUOUS CHANGES MEASURES CHANGES MEASURES • Follow up • Discharge • Care • Hospital phone calls reports integration admission • Care • Nurse • Empanelment reports integration management Team pods Continuity • • • Risk lists rates for team stratification • Disease Improve Improve and provider • Panel registries Patient care Population management quality & Health experience ACCESSIBLE ACCOUNTABLE CHANGES MEASURES Reduce Joy in CHANGES MEASURES • Extended • Access reports Cost of Practice hours • PRE Ms Panel Record Care • • • Patient portals management audits Same day • • Quality • Data access improvement dashboards Panel • • Care review management

In an era of change • The way we practice medicine is changing • Governments and society are questioning how health care is valued • We must lead to be able to adapt • We must adapt to payment models by doing things differently • Everything we do must be transparent • We must learn to measure , and measure only what matters • Learn to continuously improve, and improve by continuously learning • Hold the patient at the heart of care delivery Appreciate that a coordinated team is vital to patient centred care • 14

Sydney North PHN AGM NZ Primary Care Models 10 November 2016 Stephen McKernan QSO Partner, Advisory Oceania

New Zealand’s primary care system. Key Characteristics ► Enrolled population – unique identifier ► Capitated funding environment – but with some co-payment ► Explicit focus on health inequalities ► Established target and performance regime ► Strengthened focus on chronic disease management ► Improved access to services and pharmaceuticals – particularly for “at risk” populations ► Strong emphasis on more multidisciplinary care. New models of care ► Development and implementation of the Heath Care Home initiative Page 16

“Towards Healthy Families” Page 17

Whole-of-system analytics to support improved system performance Cost of Triage 4&5 If peer group attendances per average, 423 year: fewer; if DHB, 470 ED attends pa in DHB DHB $6M fewer (=$200k for - 37,000; NZ $150M ~1,500 people) Selected practice NZ - 1M If at DHB average, If at peer group 86 fewer ($260k Acute med/surg average, 48 fewer for a practice of hosps; DHB- 17,000; (=$150k) ~1,500 people) NZ – 500,000 ($2B at national prices) Selected practice Page 18

The future....disruptive technologies and consumer-led change. Interest in new types of services: Totally Totally disagree Not agree Interested Interest in service I am willing to… interested (1 or 2 on a (4 or 5 on a 5 5 point point scale) scale) Make an appointment online to see a doctor 87% 13% or organise a hospital service/appointment Be treated by a health professional instead of a 59% 11% doctor for minor / non-urgent health problems, vaccinations and basic health screenings Complete doctor or hospital registration 83% 17% details online before your visit Take medications or treatments that have been 47% 15% customised to my genetic profile Use an at – home diagnostic test kit (EG for 74% 26% Have non-urgent treatment., vaccinations and health strep-throat , cholesterol levels) and send the 45% 21% screenings at a phamacy or facility located in a information to your doctor department store Undergo genetic / DNA testing to confirm a Communicate electronically with a doctor or 43% 21% 70% diagnosis or whether I might develop certain 30% other health professional (EG email, text, diseases social media site) Have a health condition treated with a “high - tech” product EG digestible sensor that delivers Order prescription drug refills using mobile 70% 30% 37% 22% medication targeted to specific areas of the body or apps on your phone a personalised joint replacement manufactured by a 3D printer Use a device that connects to your smartphone (EG temperature, blood pressure 66% 34% Be treated by a health professional (EG registered or heart rate) and send the information to nurse, physician assistant, ambulance officer) 32% 30% your doctor instead of a doctor at an Emergency Department in a hospital Consult a doctor by video on your computer 61% 39% rather than in-person in a clinic Be treated by a health professional (EG registered nurse, pharmacist, physician assistant) instead of a 27% 38% doctor for urgent or complex health problems or Send a photo of your injury/heath problem to screening procedures 60% 40% a doctor using your computer or mobile device Receive a diagnosis/prescription/advice or undergo 19% 46% treatment/surgery by a robotic device Source: EY Oceania Healthcare consumer survey (2015) Page 19

Enhanced Nurse Clinics: an opportunity for innovation Karen Booth, President Jane Henty, Project Manager Enhanced Nurse Clinics Australi lian Prim rimary Health Car are Nurses Ass ssocia iation www.apna.asn.au Pho Phone 1300 1300 383 383 184 184

NiPHC Program 1. Transition to Practice Pilot Program 2. Education and Career Framework 3. CDM and Healthy Ageing Workshops 4. 4. Enhanced Nurse Clin linic ics The Enhanced Nurse Clinics are funded by the Australian Government Department of Health under the Nursing in Kununurra Medical- Nurse-led diabetes Primary Health Care Program 2015-18. Clinic

What is an Enhanced Nurse Clinic? Prim rimary ry heal alth car are se settin ing where th the nurse is is the the le lead ad co-ordinator of of car are an and has as a a patie ient cas aseload . . E.g. E. g.: chronic disease, wounds, prevention, diabetes. Ben enefit its: – reduced waiting time for patients – continuity of care, more face to face care – reduced pressure on medical clinics & consultant time Ballarat Community Health- Memory – whole le of of tea eam approach/ mult ltidiscip ipli linary Support Service tea eam acc ccess

Key components of a nurse-led clinic • • Identify the need and define the problem Adequate general administrative support • • Develop a business case Nurse confidence to negotiate with GPs and stakeholders • Plan your project – ‘end game’ • Nurse access to education - investment • Space & resources (IT systems/templates ) • Certainty regarding funding – recall & reviews • Establish governance structures built into model • Get organisational buy- in “whole of team • Patients attending appointments approach” • Market and communicate – pts & peers • Can be seen as a practice population health • Recruit patients activity and can be used for QI, meeting PIP & • Building partnerships SIP targets.

Nurse clinic models Bega Valley Medical Practice Companion House, Bee Junction Place Medical Carrington Health, Healthy Clinic Centre, Wound Clinic Hepatitis C Clinic

The Future of Primary Care To Change or Not to Change? Dr Magdalen Campbell

M.C. FAMILY MEDICAL PRACTICE

IPO: IMPROVING PATIENT OUTCOMES MC FAMILY MEDICAL PRACTICE Level 1: People with chronic  In practice: Exploring a model of case diseases and complex needs who management involving a Primary Care team approach including the GP, PN, frequently use hospitals Chronic disease manager and local AH Level 2: People with chronic  diseases and complex needs who In practice: more proactive approach use hospitals and are at risk of using the Chronic Disease manager hospitalisation identify and coordinating attendance at the practice, self management Level 3: People with chronic  promoted through coordination of a care cycle and groups of diseases and/or complex patients using exercise needs who are being tracking devices managed in the community In practice: focus on more proactive self care, develop an Level 4: Whole-  innovative in-practice education program population health involving local AH. promotion services

THE NSPHN PERSON CENTRED PRIMARY CARE FRAMEWORK