A systems level approach to integrated health care: 4 key functions

1. A systems level approach to integrated health care: 4 key functions Petra Bywood Jodie Oliver-Baxter Lynsey Brown 13th International Conference on Integrated Care Berlin, 11-12 April 2013

2. Integration & integrated health care Nebulous terms Over 70 terms/phrases 175 concepts or definitions Perspective driven by role Policy-makers Managers Providers Patients/consumers

3. SPECIFIC ISSUES LIKE LATE TAX RETURNS AND INTEGRATION THE

4. Levels of integration

5. Australian Health Care System Reform 2010 Centred around integrated PHC PHCOs key to integration (Medicare Locals) Policy jurisdictions National, State & Territory, shared policies Public and private health Urban, rural & remote regions Funding responsibility Commonwealth: PHC, Medicare State/Territory: Hospitals, community health

6. Mapping Policies • Aim ……develop an understanding of how governments across jurisdictions attempt to influence integration of health services at the policy level

7. Method Literature review Electronic databases, websites, grey literature Search Terms Integration, integrated care (synonyms) Policy-related documents Publicly available National, shared, State & Territory Agreements, directives, position statements, briefs, discussion papers, submissions Last 5 years

8. WHO Framework: relations between functions and objectives

9. Stewardship: How is the health and wellbeing of population protected? overarching vision and direction of health policy to establish a fair and optimal health system through governance, information dissemination, regulation and advocacy Policies/policy documents • 6 National • 6 Shared • 50 State & Territory

10. Stewardship Common • Health reform priority areas • Partnerships • PHCOs and hospitals • Across sectors • Priorities/shared goals • Level playing field • Inter-sectoral advocacy Different • Models of care • Access/rural & remote • Technology emphasis • Specific links between agencies • Emphasis on workforce • Whole of system vs joined-up approach

11. Creating resources: What resources are needed, and where? good quality, efficient health system relies on an appropriate mix of resources that involves the creation of new resources, maintenance of existing resources and distribution of resources to areas of need Policies/policy documents 3 National 1 Shared 7 State & Territory

12. Creating resources Common • Medicare Locals • Multidisciplinary • Communication • Between stakeholders • Information transfer • E-health • Human resources • Demand/supply balance Different • Context dependent resources needed • Resource availability • Primary vs.acute • Social vs. business

13. Financing : Who pays for the system? financing deals with the mobilisation, accumulation and allocation of funds to cover the health needs of the people, individually and collectively, in the health system Policies/policy documents 3 National 3 Shared 3 State & Territory

14. Financing Common • Encourage care coordination • Incentive payments • General practitioners • Activity-based funding • Implementation phase Different • Formalised financial policy plans • Timing

15. Delivering services: How well does the system perform? service provision involves the mix of inputs (human resources, physical capital, consumables) needed within a specific organisational setting to deliver good quality, effective health interventions Policies/policy documents 4 National 4 Shared 19 State & Territory

16. Delivering services Common • Community engagement • Improving • Patient experience • Continuity of care • Models • Co-location • Patient-centred Different • Composition of PHCOs • Patient vs. practice • Financing plans

17. Table 4. Commonwealth and shared policies that influence integration by means of a stewardship function

18. Challenges to integration Variability across jurisdictions Definitional problems Across documents – too ‘aspirational’ Processes? Roles? Implementation? Funding responsibility unclear Evaluation unclear Lack of detail Lack of measures

19. Summary & conclusions Australian Health Reform enabled Alignment, collaboration, consistency, clear objectives, measures & targets Opportunities Shared resources; improved care pathways WHO framework Useful organisational tool; policy levers Context, commitment and best practice The ‘will’ and the ‘way’

20. PHC RIS – our location • PHC RIS website: http://www.phcris.org.au/index.php • Contact details: petra.bywood@flinders.edu.au Flinders University, Adelaide Adelaide, South Australia