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New Zealand Respiratory Conference 2014

New Zealand Respiratory Conference 2014. Marty de Boer. NHC 2014. Disclosures. NHC 2014. National Health Committee. Section 11 Advisory Committee responsible for providing the Minister of Health with independent, evidence based recommendations on:

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New Zealand Respiratory Conference 2014

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  1. New Zealand Respiratory Conference 2014 Marty de Boer NHC 2014

  2. Disclosures NHC 2014

  3. National Health Committee Section 11 Advisory Committee responsible for providing the Minister of Health with independent, evidence based recommendations on: • Which technologies should be publicly funded in New Zealand • To what level and where technology should be provided • How new technology should be introduced and old technology removed NHC 2014

  4. What are we trying to achieve? • High quality health, wellbeing and independence outcomes for individual patients and populations • Evidence based value for money • Sustainability • Enhanced health contribution to GDP growth Sustainability: Continuing to provide the range and types of services (outcomes) currently available, or better, without incurring excessive levels of taxes and / or debt VfM = measurable health outcomes / $ value resources invested NHC 2014

  5. NHC approach … • Evidence based, management of non-drug technologies with a focus on models of care • Four domains • Clinical safety and effectiveness • Societal and ethical • Economic • Feasibility of adoption • 11 decision making criteria • A4R framework NHC 2014

  6. model of care Components • Pathway of care for 80% of target patient population • Business modelthat supports and manages the resource critical nodes in the pathway of care NHC 2014

  7. Technology management streams and tools Streams • Proactive • Reactive • Pull model • Sector Programme Budget • Tiered business cases • Notional Budget • Sector annual referral round • Innovation fund, HRC &CI Tools NHC 2014

  8. Then and Now NHC 2014

  9. Programme Budget2013 NHC analysis of 2010–2013 NMDS Mean % Price % ($1000s) Individuals % (n, thousands) Source: NHC Strategic Business Plan 2014/15–17/18 NHC 2014

  10. Four year Strategic Work Programme • Proactive • 14/15 Musculoskeletal and Eye • 15/16 Neoplastics and Endocrine • 16/17 Hepatobiliary and Kidney and Urinary • 17/18 Digestive and Mental Health • Reactive referrals • Age Related Macular Degeneration • Chronic Lower Back Pain • Intra Operative Radio Therapy • Pull model • Diagnostics, genetic testing for bladder cancer NHC 2014

  11. NHC Tiered Business Approach to Work Plans Sector Engagement and Participation Source; NHC Strategic Business Plan 2014/15-17/18 NHC 2014

  12. National Prioritisation Network ‘working together for patients and communities’ • Purpose to provide the NHC with direction, data, support and a regional perspective that enables wise and effective • prioritisation • implementation • monitoring NHC 2014

  13. NHC Notional budget management • Direct (Vote: Health) vs Indirect (Whole of Govt) • Cost avoided (‘notional’ savings) • Released value (‘real’ savings) • cost effectiveness • efficiencies • reprioritisation • Evidence based investment (expenditure) • Movement of funds between spends NHC 2014

  14. Example of a notional budget Source: NHC Executive Notional Budget paper 2014 NHC 2014

  15. Tier 1 Strategic OverviewRespiratory Disease in New Zealand • $265m public casemix hospital discharges • 10 disease states • Assess prevalence, incidence, health outcomes, health utilisation and cost • Identify the disease state for Tier 2 assessment with the aim of improving health outcomes whilst maintaining or reducing costs through the prioritisation and application of the most cost effective new and existing health technologies across a model of care NHC 2014

  16. Respiratory Working Group NHC 2014

  17. Source: 2013 NHC Executive Analysis of 2009/10–2011/2012 NMDS Source: NHC Executive analysis 2013 NHC 2014

  18. Burden of Respiratory Disease DALY Breakdown by Percentage Death Breakdown by Percentage Source: NZBDS 2013 NHC 2014

  19. Burden of Respiratory Disease Source: 2013 NHC Executive analysis of 2010–2011/12 NMDS and 2010 National Mortality Collection NHC 2014

  20. Incident Diseases Efficiency Gains Required to Reach $5 million 2013 NHC Executive Analysis of 2011/12 NMDS NHC 2014

  21. Source; NCH Decision Making Paper 2013 NHC 2014

  22. Tier 2 COPD: A Pathway to Prioritisation Source: OECD Data 2011 NHC 2014

  23. Patient numbers and costs along the pathway Source: National Health Committee Executive analysis (2013) of 2010/11 New Zealand Health Tracker NHC 2014

  24. Deprivation and Ethnicity Source: National Health Committee Executive analysis (2013) of 2010/11 New Zealand Health Tracker data NHC 2014

  25. DHB non admitted ED rate and hospital discharge variation per 100 for Maorihigh-deprivation COPD patients NHC 2014 Source :2013 NHC analysis of 2010/11 New Zealand Health Tracker data

  26. Tier 3 Assessments • Improved diagnosis / case finding • Pulmonary rehabilitation • Long term oxygen therapy • Non invasive ventilation • Advanced care planning Strategies to reduce ED presentations, admissions and inpatient costs NHC Model of Care for COPD 2013 NHC 2014

  27. NHC Innovation Fund HIP ‘bottom up’ research $1.4m NHC 2014

  28. NHC 2014

  29. Long Term Oxygen Therapy Source: NHC Executive Analysis of Garrett J, Chen B, Taylor DR. A Survey of Respiratory and Sleep Services in New Zealand Undertaken by the Thoracic Society of Australia and New Zealand (TSANZ). The New Zealand Medical Journal. 2009;122(1289). NHC 2014

  30. Source: NHC Executive Analysis of DHB Oxygen Questionnaire Data, 2014 NHC 2014

  31. NHC 2014

  32. X NHC 2014

  33. Thank you www.nhc.health.govt.nz marty_deboer@nhc.govt.nz NHC 2014

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