NHS 5YFV Vangaurds- Jo Goodfellow presentation
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Transcript of NHS 5YFV Vangaurds- Jo Goodfellow presentation
Healthy Wirral Primary and Acute Care System
Vanguard Site
Jo Goodfellow, Programme Director9th December 2015
Our new model of care
What’s our USP?
The Healthy Wirral population health management approach will be underpinned by a robust population health management platform supplied by our informatics partner who have extensive experience of working with accountable care organisations that are moving from a fee for service model to a value based model.
We will create a new care record
Focusing our approach
Information Governance
Engagement of stakeholders
High level benefits realisation
Information Governance
• Information Governance Task and Finish Group
• Working in partnership with Information Commissioners Office/HSCIC
• Development of Privacy Impact Assessment and Information Sharing Agreement
• Memorandum of Understanding
Information Governance-What did we learn?
• Constantly explore the art of the possible • We are learning too! • Cross every bridge when you come to it • Seek subject matter expert advice • Take your senior leaders with you
Stakeholder engagement
• Understanding local history and current news headlines
• Clear understanding of the change being implemented
• Stakeholder engagement strategy• Benefits analysis
High level benefits of the Population Health Management system
Benefit Type Description
Prevention Ability to stratify records distinguishing high risk, rising risk, and low risk. Interventions to prevent patient condition deteriorating
Intervention Tracking compliance to care pathway managementJoined-up care Efficient consultations through the ability to view health and social records in one place (longitudinal
record), leading to less time chasing information and improved clinical outcomes. Improved care coordination
Decision support Shared registries of patient condition groups with ability to filter and aggregate by population or organisation.
Pro-active monitoring (e.g. vital signs) to prevent deteriorating health.
Patient quality and experience
Improved communication between organisations. Reduction in duplicated tests. Reduced length of stay. Reduction in avoidable admissions and re-admissions Reduction in adverse drug interactions.
Patient self care Pro-active targeting of patient condition groups for enabling patient self care (Social Prescribing)
Population Management Opportunity to review commissioning model with improved intelligence and tracking of patient outcomes.
Opportunity for Integrated Care Co-ordination Teams that provide a responsive and person-centred approach to delivering both planned and unplanned care at home. Improve independence and wellbeing in order to avoid hospitalisation.
Where are we now?• Public engagement commences (January)• Memorandum of Understanding between
Partners (December)• Building and implementation of Diabetes and
Respiratory registries (on-going)• Commence Wellness and Depression registries
(December)• Sharing our learning and ensuring replicability
(on-going)
What matters to you?