Health Care Home. Lessons from the Vanguards. Dr Jeff Lowe

Transcription

1 Health Care Home Lessons from the Vanguards Dr Jeff Lowe Shifting care Closer to Home How Do we Transform Te Papa Wellington 27 th February 2018

2 PERSPECTIVES Chair General Practice NZ HCH National Collaborative Governance Group HCH Governance and Oversight Groups CCDHB Director Karori Medical Centre

3 PATIENT STORY PRE HEALTH CARE HOME

4 Why Health Care Home? Ageing Burnout Complexity Demand Emerging Technologies

5 Why Health Care Home? UNSUSTAINABLE Not Just General Practice The Whole of Our Health and Care System N

6 Why Health Care Home? Current Model of Care is No Longer Fit for Purpose Loss of the Joy of Practice

7 International Themes Integration Moving Care closer to home Enhanced Models of Care Patient participation Restoring the Joy of Practice

8 The Answer?

9 Health Care Home Design Building Blocks/Principles

10 Alma Ata Declaration 1978

11 Barbara Starfield

12 DOMAINS Timely Unplanned Care Proactive Care for High Needs Routine and Preventative Care Business Efficiency Key elements of the model

13 IPAC CONFERENCE Wellington 2008 Wellington 2012 Matt Handley, Group Health Seattle Midlands Health Network

14 Fertile Land Policy and Legislation Strategies Structures Funding?

15 How to Build a Health Care Home BUILDING Renovation v Rebuild WORKFORCE Re-Purpose v Restructure BUDGET Joint Investment PHOs and DHB $14/pt $16/pt

16 Capital and Coast DHB Approach

17 Started Jul % Coverage October 2018

18 Commitment not just involved

19 Early Results Look Good

20 FROM GOOD TO GREAT From My Survival to Survival of the System What Part can I Play

21 The Karori Medical Centre Experience

22 www.

23 KARORI MEDICAL CENTRE LIMITED 14,468 enrolled and funded 9% High needs Has Altered the way patients can comnicate with our and we can 5% Maoricommunicate with 3% PI our patients Practice Profile 16% Asian 9787 enrolled in MMH = 86 %, 6971 activated = 68%

24 14 GPs (8.25 FTE) KARORI MEDICAL CENTRE LIMITED Staff 8 Nurses Has Altered the way patients can comnicate with our and we can communicate 13 Support with our patients Staff(8.5FTE) Counsellor (1FTE) Practice Assistant

25 KARORI MEDICAL CENTRE LIMITED History of Innovation 1976 established 1984 computerised 1987 capitated 1993 IPA Has 2002 Altered PHO the 35,000 way patients patients can comnicate 2016 Health with Care our Home and we can communicate with our patients

26 The Manhattan Skyline

27 The Manhattan Skyline

28 PATIENT PORTAL PARTNERSHIP Has Altered the way patients can communicate with our and we can communicate with our patients Partners in care verses recipients of care

29 PATIENT PORTAL ACCESS Breaks the Constraints of the 15 min face to face appointment Easier Access to timely advice

30 MEANWHILE BACK AT KMC Culture for Change

31 The Path Enrolled Population and Community Timely Access Extended Range of Services Enhanced Workforce Facility Business Model and Funding Integrated into the Health and Care System To meet the challenges Now and in the Future

32 Welcome to the Karori Medical Centre KARORI MEDICAL CENTRE LTD

33 The Front Door to Karori Medical Centre

34 ACCESS Services *Sign Posting *Advice *Results *OpenNotes *Repeats *Appointments *e-consultations *telephone-consultations

35 CREATING CAPACITY

36 The Receptionist The Appointment Book The 15 Minute Appointment

37 THE TYRANNY OF THE 15 MINUTE APPOINTMENT

38 TRIAGE 100% Reception Nurse Doctor Creating on day Capacity to do the work that matters the most 25%

39 PATIENT PORTAL DEMAND UNPLANNED CARE Getting further up the pipeline of acute demand CAPACITY

40 Patient Portal 13% Patient makes appointment 6% Virtual consult prescription 6% Refer to other services Secure s Into Practise Virtual consult advice 35% 40% Refer to diagnostics SECURE S INWARD

41 THE BUILDING *Phones off the Front Desk *Standardisation of Clinical Rooms *Non clinical Co working space *LEAN *Extended Hours

42 WORKFORCE Knowledge and Expertise CURRENT WORKFORCE REPURPOSE Doctors Nurses Primary Health care Assistents TOP OF SCOPE Pharmacy Facilitator Health Care Co Ordinator Reception Manager Accountant PATIENTS SELF CARE

43 THE WORK *Doing the Work that matters the most *Minimise suffering *Minimise Burden on the System

44 SERVICE ELEMENTS

45 Extended Hours Reception Triage Doctor Triage Morning Huddle Extended service(poac) DVT, IV Cellulitis, Renal Colic and Retention, Minor Gynae Risk Stratification, Year of Care Planning On day appointments with Acute/Duty Doctor Team Boards Health Care Co Ordinator Patient Portal appointments, labs, repeats, open notes,secure e mails, e- consultation MDT Meetings Monitoring dropped call rate,tnaa, health targets, ED attendance, ASH rates

46 HEALTH CARE NEIGHBOURHOOD HCH MDT CSI ALLIANCE

47 Concerned she has osteoporosis DEXA scan ordered Discussion DEXA scan result ordered via MMH YOC Polypharmacy at risk of osteoporosis DEXA ordered Osteoporosis on DEXA IV zoledronic acid with Nurse Patient Story post HCH

48 Great Start to the Finished Product

49 Our approach to HCH programme In partnership with the local hospital Jointly funded GP practices applied and were selected against set criteria Gathering evidence and learning as we go Access to subject experts Detailed scoping the gap against national model of care requirements Support and guidance to write HCH implementation plan (inc. resources) Establishing regular monitoring meetings with practice HCH leads Plugging into peer support groups (both clinical & non-clinical Regular workshops and seminars as required

50 Becoming a HCH practice EOI Preparation phase HCH launch Business as usual Submission Evaluation Acceptance Readiness assessment & Scoping the Gap Workshops participation Initial necessary set up First 3 month targets Monthly visits Regular support (training, workshops) Resources Reporting Progress review

51 LEAN Peer Review sessions GPs/Nurses Peer group HCH visits Practice Managers Peer group A shared learning journey Trainings/workshops

52 Locking in accountability Agreed business rules (first 3-month achievement) Agreed health targets (8-month immunization and smoking brief advice) Monitoring progress against annual plan and budget expenditure A variety of reports e.g. quality indicator reports, Performance trend data, year two targets, etc.

53 Reports & results

54 Reports & Results (cont.)

55 Staff experience Overall improved efficiency To cope in times of great demand Role expansion & development Better workplace relationship Perceived better care for patients Higher satisfaction I m learning about things that I would not have had the opportunity to learn before I suppose the biggest change is always learning We are in a good place to handle times when we have decreased capacity with less impact on patients as we can provide other options of accessing care

56 Critical factors for a successful HCH implementation Clinical leadership & sponsorship Project Management Coordination & Collaboration Change Management Measurement & review Continuous quality improvement Access to knowledge & support

57 The HCH National Collaborative Group - Members ProCare Pinnacle Health Compass Health Pegasus Health Northland DHB alliance (Manaia and Te Tai Tokerau) Central PHO Hutt Valley DHB (Te Awakairangi & Cosine) Comprehensive Care Nelson Marlborough DHB (including Nelson Bays Primary Health and Marlborough PHO) WellSouth Primary Health Network Supporting organisations: GPNZ RNZCGP

58 The HCH National Collaborative Group - Background The HCH - elements of which were adopted from Group Health, US - was first introduced in NZ in 2011 at Pinnacle, MHN In 2015, a business case was prepared for MoH by the N4 (Compass, Pegasus, Pinnacle and ProCare) The business case requested funding over three years to support the establishment of the model, supplemented by PHO flexible funding.

59 What does the Collaborative offer? Programme support Access to HCH resources Credentialing and certification process Access to the national data set Access to PHO leads working group Learning symposium Standards development, accreditation and brand protection Advocacy for national investment Support for training, shared learning and problem solving between implementation teams

60 Where we are at Number of practices: 128 practices Population coverage: 845,187 patients Three members joined last year, and one newest member (WellSouth) joined last month International interest (LEAN conference at Stanford, Health Care Home Australia)

61 Where we are going HCH Certification Reaching a one-million coverage mark More members joining Increasing publicity: newsletter, websites, conferences, media, etc Collaborative projects: - HCH National Dataset - Reviewing HCH Model of Care Requirements - HCH Patient Experience Survey

62 HCH sign-off process Credentialing Certification Accreditation Implementation plan to achieve HCH indicators at level 4 Providing GP triage and alternatives to face-to-face consults Same-day appointment available Call management Extended hours Patient portal in place Credentialing criteria Population stratification and proactive care planning introduced Progressing all four domains