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Locality clinical partnerships – principles for contracting & funding Martin Hefford

Locality clinical partnerships – principles for contracting & funding Martin Hefford. 8 December 2011. Locality Clinical Partnership Objectives. Deliver Better, Sooner, More Convenient Healthcare Improve patient health outcomes Reduce avoidable hospitalisations

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Locality clinical partnerships – principles for contracting & funding Martin Hefford

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  1. Locality clinical partnerships – principles for contracting & fundingMartin Hefford 8 December 2011

  2. Locality Clinical Partnership Objectives • Deliver Better, Sooner, More Convenient Healthcare • Improve patient health outcomes • Reduce avoidable hospitalisations • Improve clinical governance • Deliver more integrated healthcare • Deliver better value healthcare

  3. Locality clinical partnerships: overview Locality Clinical Partnerships to commission and review the work • An opportunity to create a clinically led integrated healthcare system that bridges the divide between primary care, community health services and secondary care. • Enhancing primary care to make it more accessible, comprehensive and proactive.

  4. Enrolled populations of CMDHB service localities, Q3 2011 Source: PHO enrolment register Quarter 3, 2011, analysed by CMDH, December 2011

  5. Ethnicity of the service locality enrolled populations

  6. Proportion of locality population defined as ‘High Need’ PHO funding and monitoring frameworks include proportion of enrolled population defined as ‘high need’ – Maaori, Pacific or living in area defined as high socioeconomic deprivation (NZDep, quintile 5)

  7. Within each locality, practice age structures vary

  8. Size of practice enrolled populations

  9. How are the population distributed across practices

  10. Total hospitalisations

  11. Distribution of hospitalisations by ethnicity

  12. Crude rates acute med-surg-EC MMH by practice Note, crude rate not age standardised,

  13. EC presentations

  14. Percentage of EC presentations statistically admitted

  15. Volume of specialist OP visits

  16. Contracting for Locality Clinical Partnerships Initial thinking

  17. Alliance agreement mandates: • Locality clinical network – broad interest based membership • Leadership group – clinically lead, focused on service integration, better value healthcare, and quality improvement • Risk and gain sharing and $ commitment • Management support, incl analysis and reporting Alliance Agreement DHB PHO 1, 2, 3 Agreement Locality clinical network Management support – enablers, IS, reporting, project management

  18. GAIHN contracting guiding principles (subset) • Incentivise the achievement of outcomes not the provision of service • Build collaborative trust-based systems and processes • Keep contracting simple, collaborative and outcome focused • Have transparency in all dealings • Use a broad ‘dashboard’ of measures to prevent the manipulation of single measures

  19. Locality Clinical Partnerships - commissioning • Determine current use of primary and secondary health resources by locality (shadow budgets) • Allocate budget decision making rights to three streams: • We discuss, DHB decides (eg hospital services) • We discuss, LCP decides (eg community services) • We discuss, primary care decides (eg capitation) • Move to equitable budgets, & increase LCP decision making over time

  20. Commissioning – evolution over time

  21. Acute demand gain sharing - overview

  22. Acute demand risk & gain sharing - principles Funds that would have been used for extra hospital staff/resources will be invested in primary & community settings to buy additional services. Net gains to be re-invested in extra primary / community services – locality clinical leadership groups to advise on use. Risk of poor outcome to be shared between DHB and primary care partners (say 75:25). Acute demand targets & gains to be allocated by locality.

  23. Fitting the pieces together Regional initiatives

  24. Next steps Develop locality clinical leadership groups Use 20,000 better care days as an initial programme for contracting Use Better Sooner More Convenient Business cases to develop alternative models of care & service integration plans for localities Develop shadow budgets Put in place partnership agreements Monitor performance, evaluate, and adjust over time.

  25. Discussion points for board members Do we want to share some risk with primary care? Do we agree to take the largest share of risk? Do we agree that LCPs should decide on the use of any conserved resources? Locality Clinical Partnerships could be as an alliance agreement or a formal joint venture – thoughts? Proposed that the agreement is with PCOs (or PHOs?) but the network is wider. Thoughts? Do we consider that future employment of community health staff could change?

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