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Health Care Sydney North PHN AGM Dr Walid Jammal MBBS FRACGP DCH - - PowerPoint PPT Presentation
Health Care Sydney North PHN AGM Dr Walid Jammal MBBS FRACGP DCH - - PowerPoint PPT Presentation
The Future of Primary Health Care Sydney North PHN AGM Dr Walid Jammal MBBS FRACGP DCH MHL November 2016 An Environment of Reviews Primary Health Care Review MBS Review - GP services Health Insurance Review Practice
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The Future of Primary Health Care
Sydney North PHN AGM
Dr Walid Jammal
MBBS FRACGP DCH MHL November 2016
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An Environment of Reviews
- Primary Health Care Review
- MBS Review - GP services
- Health Insurance Review
- Practice Incentives Program
- From “volume to value”
- Value-proportional to quality and inversely
proportional to cost
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What are we going to do?
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So where are we heading?
Lewis Carroll - Alice In Wonderland (1865)
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The Triple and Quadruple Aim of Health Care
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10 Template of the future 9 Comprehensive-ness and care coordination 7 Continuity of care 4 Team-based care 1 Engaged leadership 2 Data-driven improvement 3 Empanelment 5 Patient-team partnership 6 Population management 8 Prompt Access to care
The ten building blocks of high performing primary care
Bodenheimer et al, “The 10 Building Blocks if High Performing Primary Care” Annals Family Medicine Vol 12 2014
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COMPREHENSIVE
CHANGES MEASURES
- Multi-
disciplinary care-top of license
- Chronic
disease
- Holistic care
- Data registries
- Quality
improvement
- “defect lists”
ACCOUNTABLE
CHANGES MEASURES
- Panel
management
- Quality
improvement
- Care review
- Record
audits
- Data
dashboards
COORDINATED
CHANGES MEASURES
- Follow up
phone calls
- Care
integration
- Risk
stratification
- Panel
management
- Discharge
reports
- Nurse
management lists
- Disease
registries
PATIENT FAMILY CENTRED
CHANGES MEASURES
- Patient
advisory panels
- Cultural
competency
- Focus groups
- PREM
- Patient
comments
ACCESSIBLE
CHANGES MEASURES
- Extended
hours
- Patient portals
- Same day
access
- Panel
management
- Access reports
- PREMs
CONTINUOUS
CHANGES MEASURES
- Care
integration
- Empanelment
- Team pods
- Hospital
admission reports
- Continuity
rates for team and provider
Improve Patient care quality & experience Improve Population Health Reduce Cost of Care Joy in Practice
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- The way we practice medicine is changing
- Governments and society are questioning how health care is valued
- We must lead to be able to adapt
- We must adapt to payment models by doing things differently
- Everything we do must be transparent
- We must learn to measure, and measure only what matters
- Learn to continuously improve, and improve by continuously learning
- Hold the patient at the heart of care delivery
- Appreciate that a coordinated team is vital to patient centred care
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In an era of change
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Sydney North PHN AGM NZ Primary Care Models 10 November 2016
Stephen McKernan QSO Partner, Advisory Oceania
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New Zealand’s primary care system.
Key Characteristics
► Enrolled population – unique identifier ► Capitated funding environment – but with some co-payment ► Explicit focus on health inequalities ► Established target and performance regime ► Strengthened focus on chronic disease management ► Improved access to services and pharmaceuticals – particularly for “at
risk” populations
► Strong emphasis on more multidisciplinary care. New models of care ► Development and implementation of the Heath Care Home initiative
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“Towards Healthy Families”
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Selected practice Selected practiceWhole-of-system analytics to support improved system performance
ED attends pa in DHB
- 37,000;
NZ - 1M
Cost of Triage 4&5 attendances per year: DHB $6M NZ $150M If peer group average, 423 fewer; if DHB, 470 fewer (=$200k for ~1,500 people) If at peer group average, 48 fewer (=$150k) If at DHB average, 86 fewer ($260k for a practice of ~1,500 people)
Acute med/surg hosps; DHB- 17,000; NZ – 500,000 ($2B at national prices)
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The future....disruptive technologies and consumer-led change.
Interest in new types of services:
Totally agree (4 or 5 on a 5 point scale) I am willing to… Totally disagree (1 or 2 on a 5 point scale)
59%
Be treated by a health professional instead of a doctor for minor / non-urgent health problems, vaccinations and basic health screenings
11% 47%
Take medications or treatments that have been customised to my genetic profile
15% 45%
Have non-urgent treatment., vaccinations and health screenings at a phamacy or facility located in a department store
21% 43%
Undergo genetic / DNA testing to confirm a diagnosis or whether I might develop certain diseases
21% 37%
Have a health condition treated with a “high-tech” product EG digestible sensor that delivers medication targeted to specific areas of the body or a personalised joint replacement manufactured by a 3D printer
22% 32%
Be treated by a health professional (EG registered nurse, physician assistant, ambulance officer) instead of a doctor at an Emergency Department in a hospital
30% 27%
Be treated by a health professional (EG registered nurse, pharmacist, physician assistant) instead of a doctor for urgent or complex health problems or screening procedures
38% 19%
Receive a diagnosis/prescription/advice or undergo treatment/surgery by a robotic device
46%
Source: EY Oceania Healthcare consumer survey (2015)
Interested Interest in service Not interested
87%
Make an appointment online to see a doctor
- r organise a hospital service/appointment
13%
83%
Complete doctor or hospital registration details online before your visit
17%
74%
Use an at –home diagnostic test kit (EG for strep-throat , cholesterol levels) and send the information to your doctor
26%
70%
Communicate electronically with a doctor or
- ther health professional (EG email, text,
social media site)
30%
70%
Order prescription drug refills using mobile apps on your phone
30%
66%
Use a device that connects to your smartphone (EG temperature, blood pressure
- r heart rate) and send the information to
your doctor
34%
61%
Consult a doctor by video on your computer rather than in-person in a clinic
39%
60%
Send a photo of your injury/heath problem to a doctor using your computer or mobile device
40%
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Australi lian Prim rimary Health Car are Nurses Ass ssocia iation
www.apna.asn.au Pho Phone 1300 1300 383 383 184 184
Enhanced Nurse Clinics: an opportunity for innovation Karen Booth, President Jane Henty, Project Manager Enhanced Nurse Clinics
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NiPHC Program
1. Transition to Practice Pilot Program 2. Education and Career Framework 3. CDM and Healthy Ageing Workshops 4. 4. Enhanced Nurse Clin linic ics
The Enhanced Nurse Clinics are funded by the Australian Government Department of Health under the Nursing in Primary Health Care Program 2015-18. Kununurra Medical- Nurse-led diabetes Clinic
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What is an Enhanced Nurse Clinic?
Prim rimary ry heal alth car are se settin ing where th the nurse is is the the le lead ad co-ordinator of
- f car
are an and has as a a patie ient cas aseload.
. E. E.g. g.: chronic disease, wounds, prevention, diabetes.
Ben enefit its:
– reduced waiting time for patients – continuity of care, more face to face care – reduced pressure on medical clinics & consultant time
– whole le of
- f tea
eam approach/ mult ltidiscip ipli linary tea eam acc ccess
Ballarat Community Health- Memory Support Service
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Key components of a nurse-led clinic
- Identify the need and define the problem
- Develop a business case
- Plan your project – ‘end game’
- Space & resources (IT systems/templates )
- Establish governance structures
- Get organisational buy-in “whole of team
approach”
- Market and communicate – pts & peers
- Recruit patients
- Building partnerships
- Adequate general administrative support
- Nurse confidence to negotiate with GPs and
stakeholders
- Nurse access to education - investment
- Certainty regarding funding – recall & reviews
built into model
- Patients attending appointments
- Can be seen as a practice population health
activity and can be used for QI, meeting PIP & SIP targets.
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Nurse clinic models
Companion House, Bee Healthy Clinic Bega Valley Medical Practice Junction Place Medical Centre, Wound Clinic Carrington Health, Hepatitis C Clinic
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The Future of Primary Care
To Change or Not to Change? Dr Magdalen Campbell
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M.C. FAMILY MEDICAL PRACTICE
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IPO: IMPROVING PATIENT OUTCOMES
MC FAMILY MEDICAL PRACTICE
Level 1: People with chronic diseases and complex needs who frequently use hospitals
Level 2: People with chronic diseases and complex needs who use hospitals and are at risk of hospitalisation
Level 3: People with chronic diseases and/or complex needs who are being managed in the community
Level 4: Whole- population health promotion services
In practice: Exploring a model of case management involving a Primary Care team approach including the GP, PN, Chronic disease manager and local AH In practice: more proactive approach using the Chronic Disease manager identify and coordinating attendance at the practice, self management promoted through coordination
- f a care cycle and groups of
patients using exercise tracking devices In practice: focus on more proactive self care, develop an innovative in-practice education program involving local AH.
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THE NSPHN PERSON CENTRED PRIMARY CARE FRAMEWORK
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