Integrating Primary and Community Care. CAHSPR May Carole Gillam, Dean Brown, Shannon Berg, Laurie Ringaert

Transcription

1 Integrating Primary and Community Care CAHSPR May Carole Gillam, Dean Brown, Shannon Berg, Laurie Ringaert

2 Provincial Goal British Columbians will have the majority of their health needs met by high-quality community-based health care and support services. to be achieved through the creation of an integrated system of primary care and community care services. Source: Ministry of Health Health Service Plan 2010/ /13 2

3 Setting the Stage Complex medical, physical, emotional, cognitive and social needs Professional domains are different: Acute, long term/ community care, and behavioral health differ in terms of professional identities and roles, culture and language, clinical philosophies, service delivery methods, and power relationships Ongoing care needs with acute/chronic symptoms that are often unstable, unpredictable and difficult to manage or control Frequent interactions with providers, and difficult transitions within and between systems and settings High risk of avoidable hospitalizations and premature institutionalization Access, continuity and coordination problems High costs of care, increasing acute and emergency utilization. Fragmented, misaligned policy-making, regulation, and financing; Poor collaboration at the organizational and provider levels within and between the various sectors/systems Lack of a single inter-professional team and/or entity with responsibility for all care, outcomes, and costs. 3

4 Primary care fit for the future Attributes Comprehensive Patient centered Co-ordinated Continuous if required Accessible Safe with high quality Population focused Sustainability Financial Workforce Public trust Adapted from Agency for Healthcare Research and Quality

5 My Job? To navigate the change 5

6 The Health Authority Primary Care Paradox. a paradoxical situation: the tension between the relative weakness and unattractiveness of this level of care versus the intention to assign critical strategic functions to it From: Primary Care in the Driver s Seat? Saltman, Rico and Boerma (eds)

7 Our starting point a healthy disrespect! 7

8 More optimistically Challenges Silo d approach to care delivery No formal relationship between Health Authorities and Family Physicians Historical conflict Lack of common framework Opportunities Commitment to look at things differently Creation of Divisions of Family Practice Early successes in other jurisdictions Patient involvement 8

9 Has it worked elsewhere? Go to the Literature. Physician networks in the UK, New Zealand and Australia (Russell et al. 2010) Accountable care organizations in the US (Shortell et al. 2009) Leadership and Primary Care transformation (Donahue et al. 2013) 9

10 My Tool Box Provincial partnership support Building on Practice Support Program Legacy Visionary colleagues Divisions of Family Practice Relationship building skills Committed and visual senior leadership (what ever level it was at) Optimism, naivety, a thick skin and a strong supportive team 10

11 Controversial Math in History 11

12 Controversial Math in History e = ma 2 e = mb 2 e = mc 2!! 12

13 Controversial Math in BC History. BCMA + MOH =??? 13

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15 Well, yes. But today. 15

16 Collaboration! BCMA + MOH = GPSC Integration around Primary Care First contact GPs perform 80% of all care. Maintain continuity Lowers cost, better outcomes. 16

17 Divisions of Family Practice Umbrella organizations of local GPs Non profit societies! 90% of BC GPs! TWO PILLARS GP Infrastructure System Improvement CSC= DOGP + VCH+BCMA+MOH 17

18 North Shore North and West Vancouver Population 185,000 Departure of GPs from Lions Gate Hospital From 120 to 35 Angst, isolation and expense Hospitalist$ 18

19 NS Division Supporting Ourselves GP Specialist Dine and Learn High Needs Unattached Palliative Care Mental Health Addictions EMR/IT 19

20 NS Activity 2013 con t Ortho Referral Pathway Psych Consult Clinic HealthConnection : High Needs Clinic: IT PITO evolution Cerner : $0.5 B Acute Care Data Silo?? 20

21 Additional Areas - BC Local initiatives Physician Data Collaborative Divisions and GPs own and manage data: practice, group, region Facilitates evaluation, research, care planning Data-sharing among EMRs: create an API IPCC Integrated Primary and Community Care GPSC Attachment Initiative 21

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23 Vancouver Coastal Health Current Home & Community Care Services Home Health Assisted Living Residential Care Hospice, Convalescent Care, Respite Care Case Management, Nursing, Rehab, Home Support, 23

24 Ministry of Health Health Authorities Division Home & Community of Care Legislation/ Policy Home & Community Care Priorities & Initiatives Ministry of Health Monitoring and Finance Division VCH Home & Community Care Council Other VCH Councils and Programs VCH Priorities and Initiatives VCH Budget Coastal Community of Care Vancouver Community of Care Richmond Community of Care Residential and Assisted Living Services Emergency Services Acute Care Services Community of Care Priorities and Initiatives Community of Care Budget 24

25 Residential and Assisted Living Services Emergency Services Acute Care Services Division of Family Practice Initiatives and Priorities Community of Care Budget Community of Care Priorities and Initiatives Mental Health & Addiction Services Collaborative Services Committee 25

26 Home and Community Care 26

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28 The Process of Integration RELATIONSHIPS COLLABORATIVE SOLUTIONS INTEGRATION Knowing one another Building trust Sharing knowledge & information Learning Identify opportunities Finding and implementing solutions to problems (gaps) Sharing resources to make it work Working together respectfully & transparently Working to benefit patients & community & providers

29 Critical Key Stakeholders At each table we bring together a variety of stakeholders to understand issues and shape the new process and direction Physician s Community Service Providers Patients Families VCH Health Care Providers

30 We Include Perspectives From Different Stakeholders

31 System Changes are Needed Analyze current system and look at gaps, barriers Change the way we do things Broaden our teams Recognize community resources and services Change the way we communicate Change the way we design and create systems to involve key stakeholders Physician Other Health Provider Patient/Client

32 Health Care Transformational Change is Complex Systems Change Complexity Uncertainty Non-linear Emerging Innovations Co-evolving between partners 6/7/2013

33 Developmental Evaluation

34 6/7/2013 L.Ringaert VCH

35 Steering Committees Survey-GP s Does participation on the Committee enable you to: Engage with teams to co-design an initiative? Engage with teams to identify solutions to long-standing problems? Engage with teams to share decisions on quality improvement or system redesign? 6/7/2013 L.Ringaert VCH

36 Steering Committee-GP Survey What are the successes of working together in a partnership? What challenges/drawbacks have you experienced? Do you feel your voice is heard? Have you formed new relationships/partnerships? Have you increased awareness of other services? 6/7/2013 L.Ringaert VCH

37 Observations Neither MDs nor HAs are quick to change Solutions to Acute s problems are in Primary and Community care. We need one EHR to replace the current Tower of Babel. Relationships and processes are being forged where none existed. All sides are optimistic 37

38 Integrated Primary & Community Care:

39 Contact Information Carole Gillam, Executive Director, Primary Care, VCH: Dean Brown, Chair NS Division of Family Practice: Shannon Berg, Executive Director, Home and Community Care: Laurie Ringaert, Regional Evaluation Manager, Primary Care: 39