SESSION 4: Purchasing Sustainable Care for Patients across the Care Continuum

1. SESSION 4: Purchasing Sustainable Care for Patients across the Care Continuum Mr Michael Di Rienzo Chief Executive, Hunter New England LHD

2. Purchasing Sustainable Care for patients across the Care Continuum Michael Di RienzoNSW Health Symposium19th June 2014

3. Purchaser/Provider Environment Ministry purchases activity streams from Local Health Districts at an efficient price Activity levels negotiated (including growth) Adjustment factors applied to activity trend Reducing price paid by the purchaser Only paid for purchased activity Access, Quality and Patient Safety targets to be met Demand is greater than available funding Initial purchases - Acute Inpatients and Emergency Department Maturing, with purchase of additional activity streams - mental health, sub acute and non admitted activity LHD’s must manage total costs to equal or less than state efficient price Capped total funding

4. Planning and Accountability Framework We need to be proactive and adopt a forward planning approach 3 year Strategic plan and annual operational plans must be aligned to service agreement- purchased activity, clinical quality and safety targets At Hunter New England we have developed a robust planning and accountability framework able to cascade accountability to front line management and staff With an emphasis on better care (patient quality, safety and experience) will cost less

5. State Government HNE Health Planning and Accountability Framework State Plan - 2021 (10 year horizon) Ministry of Health NSW Health Plan (3-5 years) Service Agreement Local Health District HNE Health Strategic Plan/s (3-5 years) HNE Health Operational Plan (12 Months) Network Portfolio Network/Portfolio Operational Plan (12 Months) Service Facility Service/Facility Operational Plan (12 Months) Individual 90 Day Action Plan Individual Performance Development Review (PDR) March 2012

6. HNE HEALTH STRATEGIC DIRECTIONS Excellence - Every Patient, Every Time

7. Performance Accountability Management (facilities & services) and Clinicians (clinical services, clinical streams and networks) Aligned to LHD Strategic Plan (Aligning behaviour) 90 Day action plans including activity, quality and safety targets reviewed at Monthly Accountability Meetings Maintain cost centre management against budget (focus on cost drivers)

8. Managing Activity and Cost Accurately measure amount and complexity of activity streams Cascade activity targets to facility and service level Provide good quality data Share information with clinicians Provide good mechanisms for communication Set and manage cost components of each activity stream to budget Fixed, Variable and Overheads

9. Managing Activity & Cost Appropriateness of care provided Over treatment Unwarranted Variation Evidence based care Futile care New models of care Replace not duplicate Telehealth Translate research and innovation into best practice LHD ACI/CEC

10. Managing Activity & Cost Develop partnerships with alternative providers Medical Locals NGO’s NSW Ambulance Private sector Better Care Costs Less Focus on quality, safety and patient experience Drive improvement through clinical benchmarking

11. Partnerships with HNE Hunter Medicare Local/Hunter Health Alliance Health Pathways Patient Info GP After Hours Rural Doctors Network/Hunter Medicare Local/NSW Ambulance/Community Bulahdelah Hospital GP VMO’s Critical Care Telehealth Hunter Medicare Local/Residential aged care ACE Program NGO’s General Counselling