Www.wentwest.com.au Illawarra-Shoalhaven Medicare Local Illawarra-Shoalhaven Medicare Local Primary...

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Illawarra-Shoalhaven Medicare LocalPrimary Health Care Conference 22 November, 2014

Making Integrated Service Delivery a RealityA Western Sydney Perspective

Di O’Halloran

Chair, Western Sydney Medicare Local (WentWest)

Member, WS LHD Board

Conjoint Professor, Dept of General Practice, UWS

D O'HALLORAN- ILLAWARRA phc coNF - NOV 2014

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Overview: Making Integrated Service Delivery a Reality

Integrated care is patient centred care

Health as a Complex Adaptive System

PHNs’ role in Integrated patient centred care

How far down the reform road have we travelled?

Some Western Sydney Experiences- A matter of principle - HealthOne - Local Community Partnerships- Health Pathways- Integrated Care Program

Words of Wisdom from elsewhere

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Delivering Integrated Services is only possible if care is truly patient centred

Care which imposes the patient’s perspective as the organising principle of service delivery makes redundant

old supply-driven models of care provision... .... Integrated care enables health and social care provision

that is flexible, personalised, and seamless

(Lloyd & Wait 2005)

PHN structure should ideally reflect their functionPHN’s role in the system should be for all not just some


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Regional Primary Health Care Organisations’ Core Role?

To lead, support and manage the transition of our fragmented, under-resourced, inefficient and inequitable PHC sector to achieve...

An integrated cost effective, equitable and patient centred PHC system forming the foundations of a Top Down, Bottom Up Health System, with Quality General Practice central

How ready is our health system for this transition?


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Health: a Complex Adaptive System with Right and Wrong System Drivers

Health care vortex - Joachim Sturmberg - 2010

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How Far Have We Come in Reforming the Health System to Deliver Integrated Care?

Analysis of Community Health Needs?Agreed National Health System Vision?

National Health Values, Policy and Key Outcomes Framework? High level National Primary Health Care Policy?

COAG PHC Strategic Framework Bilateral State Health Plans?

Regional LHDs, MLs, LHD-ML partnerships, stakeholder collaborations

Strong, integrated PHC sector – Quality General Practice CentralEquitable, accessible quality care, esp. for those at risk

Empowered patients and communities

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A Western Sydney Perspective on ML/PHN Roles and Integrated Care

WentWest – Western Sydney Medicare Local and Regional Training Provider – matched

boundaries with WS LHDLocal Area Population

Auburn 76,519Baulkham Hills - Central 75,684Baulkham Hills- North 57,192Baulkham Hills - South 43,611Blacktown - North 100,096Blacktown- South-East 97,379Blacktown- South-West 102,322Holroyd 100,122Parramatta - Inner 47,750Parramatta - North-East 46,387Parramatta - North-West 36,611Parramatta - South 36,683Total 820,356

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WentWest: Western Sydney Medicare Local


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WS ML Operating Principles

• Support the provision of person‐centred, integrated, coordinated care, reflecting Medical Home principles

• Enhance health literacy and self care capabilities for individuals, families and communities

• Design locally‐responsive and equitable services by working with local communities and building on what already exists

• Strengthen quality, scope, connectedness and capability in general practice and primary health care

• Promote innovation, integration and continuous improvement to increase quality, safety and equity in all health care

• Work across sectors to influence socio‐economic determinants of health• Integrate teaching and research into health service planning, delivery and

evaluation

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Regional PCO/PHN Leadership at Three Levels

Local Community Partnerships• Needs assessment• Cross sector

coordination • Responding to

diversity and Closing the Gap

Programs and Projects• “Smart

commissioning” • GP & AHP capacity

building• Innovative

solutions and partnerships

Regional leadership • Health planning

and engagement• Enabling

investments and infrastructure

• Structuring consumer engagement

Building a “bottom up” approach supported by regional leadership and a strong evidence base

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2012 WS ML-LHD Partnership Matrix Partnership Agreement on Shared Priorities

Health Service Priorities Cross Service EnablersPopulation Health HealthOne

Child and Family Health Local Community Partnerships

Chronic and Complex Illness e-Health, PCEHR

Aged Care Health Pathways

Mental Health (inc. ATAPS, PIR, hs) GP After Hours

Aboriginal Health Intensive Practice support

+ Integrated Care Program now incl. PCMH

REDE Framework Research, Evaluation, Development and Education Framework

Think & behave as if we are one health system


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Some Western Sydney Experiences with Integrated Care

• HealthOne• Local (LGA) Community Partnerships

• Health Pathways• Diabetes Care• NSW Integrated Care Program

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High priority, high risk groups New integrated models of care

New service models including Specialist support, outreach)

Targeted special services: clinics, outreach, education

‘ ‘Foundation’ service pathwaysPopulation planningCapability building

Review and/or audit of all usual community health service business processes to enhance relationships, quality of care and communication processes with general practice Develop single point entry, common assessments.

Ongoing joint population and service planning processes Development of e-connectivity, Health Pathways Build General Practice quality. scope and capacity Engage local community groups, NGOs, schools in planning Support people in their own homes and communities

The ‘Universal Triangle’

Development of targeted services, special purpose clinics to meet id’d needs of community, community groups and GPs, and/or develop intensive support/recruit to high risk programs eg Connecting Care, HO

HealthOne Patient centred, integrated MoC for high priority groups Enrolment, Care Plan

Wrap around care


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HealthOne: Keys to successful implementation

• Identify, invest in, professional leaders• Identify shared culture, values, priorities• Detailed local data analysis• Delegated responsibilities• Facilitated local strategic planning

• Dedicated GP Liaison Nurse positions• Progressive Model of Care development• Progressive Cross sector engagement• Referral and communication pathway

review against targets• Build quality and capability

• Behave as if philosophy ...

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Local Community Partnerships

LGA Level

• ML, LHD, AMS, other sector agencies, schools, local councils, juvenile justice ...

• Detailed Community profiles for every LGA – support cross sector planning and priority setting

• Expanding ML-initiated, schools based program to lift AEDI levels in disadvantaged schools

Local Level

• Community Health centre as local Health hub

• Cross sector outreach services to disadvantaged communities

• SHAPE – exercise, diet, nutrition program – positive evaluations

• Multiple Refugee Health, CALD initiatives

• Thrive at Five - Doonside

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Health Pathways

• Commenced 2013 with Diabetes Program • GPs, Specialists, Allied Health, Consumers engaged • Aim is link up electronic systems, develop patient portal

• 72 Pathways developed, 144 in development, but ...• more important to ensure patient experience is consistently positive• Requires continuing feedback, evaluation and improvement

• Pathway development process critical in breaking down professional and service barriers

• Health Pathways: about more than efficiency and consistency, can lead to significant clinical redesign, devolution, integrated care gains

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Integrated Care Program

• NSW Health Initiative• WS one of three demonstrator sites• WS LHD-ML partnership focussing on three Chronic Conditions with

high hospital utilisation

• Collaborative development of tiered evidence based Model of Care• Difficulties significant and include:

- pimple on pumpkin syndrome

- generalist versus specialist emphasis

- appropriate investment in building GP capability

- achieving right core drivers for a Complex Adaptive System

• ML – strong emphasis on Patient Centred Medical Home principles

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Integrated Care: Critical success factors (McKinsey)

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Overview: Making Integrated Service Delivery a Reality

Integrated care is patient centred care

Health as a Complex Adaptive System

PHNs’ role in Integrated patient centred care

How far down the reform road have we travelled?

Some Western Sydney Experiences- A matter of principle - HealthOne - Local Community Partnerships- Health Pathways- Integrated Care Program

.... and finally, a few Words of Wisdom from elsewhere

www.wentwest.com.au


“Find common cause withpartners and be preparedto share sovereignty”

(Kings Fund 2013)

http://www.google.com.au/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&docid=Q5X7BPXFcGQ8MM&tbnid=ObPaieQerBSqMM:&ved=0CAcQjRw&url=http://mozy.com/blog/small-business-tips/navigating-a-successful-platform-partnership/&ei=NI8iVI-8PJPM8gWe8YDYDA&bvm=bv.75775273,d.dGc&psig=AFQjCNHnJhe9S8brExocLmKh79MhnOsEcw&ust=1411637395826646

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Kings Fund: Top 16 needs to make Integrated Care happen at Scale and Pace

• Find a common cause with partners and be prepared to share sovereignty• Develop a shared narrative to explain why integrated care matters• Develop a persuasive vision to describe what integrated care will achieve• Establish shared leadership

• Create time and space to develop understanding and new ways of working• Identify services & user groups where benefits from integrated care are the greatest • Build integrated care from the bottom up as well as the top down• Pool resources to enable commissioners & integrated teams to use resources flexibly• Recognise that there is no ‘best way’ of integrating care• Support and empower users to take more control over their health and well-being• Share information about users with the support of appropriate information governance• Use workforce effectively and be open to innovations in skill mix and staff substitution.

• Innovate in use of contracting & payment mechanisms, use of the independent sector• Set specific objectives and measure and evaluate progress towards these objectives• Be realistic about the costs of integrated care• Act on all these lessons together as part of a coherent strategy

D O'HALLORAN- WENTWEST-IPHC REFORM CONF-MARCH 2014

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Primary Care Trajectories(From ‘GPs at the Deep End’: Glasgow)

• From pastoral to interventional care which alters natural history ..• From reactive care (focus on presenting complaint) to anticipatory care

(delay/prevent future problems)• From passive to active patients with increased agency, responsibility ...• From single episodes of care to sequences of care requiring continuity,

relationships and trust

• From individual to population care, including equity based on need• From pragmatism and good conscience to systematic efforts to improve

quality of care base on evidence and audit • From individual professional activities to teamwork• From local to wider team, involving colleagues from other agencies• From isolated local units ..to consideration of PHC as a whole system• From medical .. to social model of health and health care within communities• From professionalism to participatory democracy• (General Practice) Leading all or some of the above

• Professor Graham Watt http://www.gla.ac.uk/researchinstitutes/healthwellbeing/research/generalpractice/ deepend

•

http://www.gla.ac.uk/researchinstitutes/healthwellbeing/research/generalpractice/

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Thank You

Questions?

Contact: Di O’Halloran

[email protected]

Mobile: 0400 010 840

mailto:[email protected]

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