NIHB STRATEGY SESSION USING A CURRENT STATE MAPPING APPROACH TO CREATE IMPROVEMENTS IN PROVINCIAL SERVICE PROVISION TO FIRST NATIONS Mara Andrews Senior Consultant, Kahui Tautoko Consulting Ltd Vancouver BC March 2014
OVERVIEW OF PRESENTATION First Nations / Aboriginal Primary Health Care Service Model Current state mapping of First Nations community access to services in the model How the results have influenced changes in NIHB and service provision by regional health authority RATIONALE The Province has responsibility for providing all aspects of health services to all residents of British Columbia, including Status Indians living on and off-reserve Tripartite First Nations Health Plan Provisions of Canada Health Act BC Medicare Protection Act (for primary care) BC Hospital Insurance Act (for hospital care) In order for the province to meet it s obligations to First Nations communities - Nations need to know: what they SHOULD be receiving whether they are receiving it and how it works what they are NOT receiving How the provincial services support and enhance or complement their federal programs (add to federal programs not replace or duplicate)
Example of Glossary for each cluster
WORKING TOWARD ACHIEVING THE IDEAL MODEL IN THE REGION S 15 FIRST NATIONS COMMUNITIES (ON RESERVE) Mapped current services against the model in each First Nations community to identify: What is working well in terms of access and who provides the service (FNIH, First Nation, RHA & local health practitioners including physicians, dental, pharmacy etc) Where there is positive integration between the First Nation community and the RHA and other practitioners What is not working well (jurisdictional challenges, quality improvement, cultural competency) Gaps & opportunities Produced 15 individual maps including workforce (employed & visiting) Did a Regional analysis of trends across all communities to inform the community and the RHA of areas to improve
DASHBOARD (15 FN communities) 69 service lines assessed (7 clusters) Green means good access to the service in the model Orange means there is access but quality issues Light red means there is an insufficient service to meet demand Red means there is no service (outright gap) There is a narrative behind each service line & rating for each community
WORKING TOWARD ACHIEVING THE IDEAL MODEL IN URBAN VANCOUVER Vancouver: city with 3 rd largest Aboriginal population: Gathered data on current services for Aboriginal populations in these areas from 47 service providers including specific Aboriginal organizations delivering services (e.g. Friendship Centres), Non- Government Organizations with high % Aboriginal clients, RHA services GAPS: Incorporating Traditional, Cultural and Spiritual supports into all services (especially across the RHA s Community health clinics, Home Health and Mental health & addictions services) Prevention Programs: Smoking cessation (free), injury prevention and alcohol and drug prevention programs; Elders programs and some additional youth programs Mental Wellness & Substance Use Programs: Counselling, social work and clinical psychology (IRS counselling for trauma, grief and bereavement) addiction treatment beds Health Practitioners: Supporting transport and access to attend dental and optometry care Enablers: Increasing Aboriginal advocacy capacity for providers and clients in community-based care (e.g. Aboriginal Navigators for providers and their clients similar to those operating primarily in hospital settings)
LOCAL HEALTH AREAS reviewed as part of Urban Aboriginal PHC Mapping Process 3,571 NORTH & WEST CITY 1,305 4,405 DTES 1,685 WESTSIDE NORTHEAST 1,590 MIDTOWN 1,690 SOUTH 1,125 RICHMOND 1,214
NON-INSURED HEALTH BENEFITS Example community NATION NIHB Claims 2008-2009 2010-2011 2011-2012 TOTALS Percentage Share of Costs Podiatry $1,671.55 $0.00 $0.00 $1,671.55 0% Prosthetic $1,777.40 $0.00 $0.00 $1,777.40 0% Nuclear Medicine $2,930.80 $1,431.35 $0.00 $4,362.15 0% Psychiatrics / Men H $0.00 $3,817.45 $2,119.68 $5,937.13 0% Vascular surgery $924.05 $997.70 $5,506.39 $7,428.14 0% Orthotics $1,643.30 $1,140.30 $6,181.72 $8,965.32 0% Haematology $2,471.10 $1,759.10 $5,133.52 $9,363.72 0% Rehabilitation $5,748.42 $1,902.71 $2,756.51 $10,407.64 0% Audiologist $10,565.35 $4,603.95 $1,557.05 $16,726.35 1% Oncology $0.00 $0.00 $17,572.69 $17,572.69 1% Endocrinology $2,107.15 $14,097.92 $2,375.85 $18,580.92 1% Optometry $20,014.70 $693.40 $0.00 $20,708.10 1% Gynaecology $12,489.35 $2,483.82 $11,579.95 $26,553.12 1% Emergency $12,204.10 $14,263.64 $5,565.50 $32,033.24 1% Dermatologist $9,881.30 $11,314.82 $10,912.18 $32,108.30 1% Addiction (Resid. Tmt) $18,665.66 $8,519.32 $5,573.64 $32,758.62 1% Plastic surgery $17,500.70 $9,772.78 $7,957.19 $35,230.67 1% Allergist $9,066.40 $17,975.47 $16,989.43 $44,031.30 1% Urology $12,072.14 $22,396.17 $25,392.27 $59,860.58 2% Paediatrics $18,138.75 $17,470.73 $28,413.18 $64,022.66 2% Nephrology $44,147.63 $6,693.60 $15,527.01 $66,368.24 2% Rheumatology $14,184.50 $24,722.70 $27,588.69 $66,495.89 2% Gastroenterology $17,168.90 $36,680.89 $17,297.14 $71,146.93 2% Radiology / Xray $41,809.09 $7,568.74 $24,657.36 $74,035.19 2% Internal Medicine $45,010.05 $19,471.58 $31,144.83 $95,626.46 3% Neurology $22,532.35 $27,753.07 $60,829.86 $111,115.28 3% Surgery $19,387.50 $20,543.28 $74,469.49 $114,400.27 3% CT Scans $37,425.95 $50,366.70 $38,562.04 $126,354.69 4% Orthopaedics $65,378.32 $47,430.97 $37,705.82 $150,515.11 5% ENT / Otolaryngologist $19,150.32 $73,527.58 $63,757.45 $156,435.35 5% Cardiologist $36,177.70 $46,076.47 $85,457.94 $167,712.11 5% Gen. Surgery $60,698.56 $65,687.61 $55,582.47 $181,968.64 6% Opthalmology $42,005.08 $52,687.54 $105,943.99 $200,636.61 6% Dental / Orthodontist $52,723.33 $62,208.84 $86,485.82 $201,417.99 6% Ultrasounds $53,520.96 $87,532.39 $77,498.85 $218,552.20 7% Obstetrics/Maternity $29,824.80 $88,652.07 $144,633.47 $263,110.34 8% Other $221,208.24 $243,402.21 $96,845.12 $561,455.57 17% $982,225.50 $1,095,646.87 $1,199,574.10 $3,277,446.47 100% All items below the dotted line account for almost 80% of total expenditures over this 3 years
NON-INSURED HEALTH BENEFITS Example community $600,000.00 $500,000.00 $400,000.00 $300,000.00 $200,000.00 $100,000.00 $0.00
IMPACTS OF THE NIHB ANALYSIS & LESSONS Presenting information with the RHA has made them see how much it costs communities to come to their services It has encouraged some specialists (especially those who are nonequipment dependent) to look at ways to go to the community instead of people travelling e.g. Rheumatologists for arthritis Nephrologists Help for people with allergies Pediatricians Use of tele-health is increasing to save travel time, cost and impacts on First Nations families NIHB savings for communities Creating stronger relationships between specialists and Health Directors / FN health centres for shared patients improved referrals More use of provincial travel assistance program (TAP)