POPULATION HEALTH PLANNING IN THE NEW PRIMARY HEALTH CARE ENVIRONMENT

1. POPULATION HEALTH PLANNING IN THE NEW PRIMARY HEALTH CARE ENVIRONMENT Vivian Lin School of Public Health

2. HOW MANY PLANNERS DOES IT TAKE TO CHANGE A LIGHT BULB?

3. Medicare Locals and the population health perspective Planning as a tool for meeting population health needs Planning as a social and a technical process OVERVIEW

4. KEY MESSAGES • Don’t go on a data trawling exercise • Focus on the problem to be solved • Start with population/community/consumers • Talk to stakeholders • Think implementation

5. Identify health needs of local areas and develop services, including focus on prevention and early intervention Improve patient journey through integrated and coordinated services Support clinicians and providers to improve care, particularly chronic disease Implement successful programs Efficient and accountable governance and management MEDICARE LOCALS’ OBJECTIVES

6. LINKS TO OTHER REFORMS • Collaborate with Local Hospital Networks • Support development of e-health • Improve planning of primary health care services to respond to local needs • Support development of primary health care infrastructure • Enhance primary health care workforce to meet local needs • Improve disease prevention and management, and improve access to services

7. ACTIVITES BEYOND DIVISIONS • Coordinate range of primary health care practitioners • Undertake local health planning, identify gaps in services and opportunities for better targeting • Support implementation of initiatives to improve prevention and management of disease • Administer flexible funding pools to target gaps in services • Improve coordination and integration of care across health system • Identify local health needs and address these through coordinating and funding services • Provide information about local services • Fulfill transparency, performance and accountability arrangements

8. Focus on obesity: Nutrition (healthy eating) and physical activity (active living) Settings: schools, workplaces, communities GP role: motivational counselling, health education, service referral Other PHC roles: group work, local environmental change PRIMARY PREVENTION IN PRIMARY HEALTH CARE: Australian priorities

9. AUSTRALIAN BETTER HEALTH INITIATIVE: Population and health system perspective

10. POSSIBLE POPULATION HEALTH ACTIVITIES • Discrete programs – nutrition, physical activity, tobacco • Continuum across service system – primary, secondary and tertiary prevention • Integrated public health strategies • Individual – clustering of health issues and linking providers • Population – partnership-based system • Place/setting – social enterprise

11. Population-based planning – health, health risks, and health services; infrastructure, capacity, and linkages; evidence of effectiveness? Implementation: Resource allocation – Pooled? Purchasing? Incentives? Human resources development – developing skills and culture of partnership, innovation and learning Information systems – clinical, population, organisational performance Performance monitoring – indicators of health, health risks, and health services utilisation? efficiency and effectiveness? quality? community capacity? TOOLS TO SUPPORT INTEGRATED APPROACH TO POPULATION HEALTH

12. Deliberately achieving particular objective by assembling actions into some orderly sequence Identifying goals/objectives and choosing among alternative means to achieve them Involves choice and change as well as technical and rational procedures DEFINITION AND KEY ELEMENTS OF PLANNING

13. Access - geographical, financial, architectural, linguistic Equity - in access, in outcomes Cost - price, value for money Efficiency - output given input Quality - appropriate treatment, responsive service Effectiveness - health outcomes achieved CORE CONCEPTS IN HEALTH PLANNING

14. Population-based 1. Select health issue 2. identify risks 3. evaluate population risk level 4. compared need with current program 5. adjust resources 6. evaluate Institution/program-based 1. Select health service 2. determine current demand 3. forecast future demand 4. compare demand with current capacity 5. adjust resources 6. evaluate APPROACHES TO HEALTH PLANNING

15. HEALTH NEEDS – Central to population health planning and prevention • Groups! – health is not randomly distributed • People live, work and play in context – demographic, social, economic, cultural factors matter • Objective measures + subjective status – perceptions are realities • Health hazards and risks – present and future • Relativities - comparison with peer communities/population groups

16. UTLISATION AND SERVICE SYSTEMS – understanding from population perspective • Diverse patient journeys • Falling through the cracks • Parallel primary care systems • Financial, cultural, psychological barriers to care seeking • Level of health literacy

17. Analysis of stakeholders Forecasting Making choices Appraisal of options Economic evaluation Social assessment Feasibility analysis (technical and political) TOOLS – Social and technical

18. Health services Social services Local government Community and consumer/patient organisations Private sector Frontline staff PARTNERSHIPS – balancing efficiency & effectiveness

19. GOVERNANCE – Managing the course of events • Participation ladder: information – consultation – collaboration – ownership • Who participates – advisory or decision-making? Who decides in the first place? Accountability to whom? And how? • Successful partnerships – safe environment, clear decision-making procedures, focus on joint priorities, win-win, draw on complementarities, share the credit

20. PLANNING FOR IMPLEMENTATION FAILURE

21. CONCLUSION: PLANNING AS TECHNICAL AND SOCIAL PROCESS TECHNICAL SOCIAL Assessing expectations Stakeholder management – from consultation, to participation, to ownership Optimising – selecting a balanced portfolio Governance of planning process • Assessing needs and demands • Forecasting • Analysing resource capacity and constraints • Assessing evidence and potential for interventions • Assessing costs and distributional benefits