Russell Kennedy NFP Seminar:Strategic challenges facing primary health from a not-for-profit perspective

24 August 2016

Michael Gorton AM @GortonM@RussellKennedy_

Primary Health NetworksCurrent landscape, opportunities

and challenges

24 August 2016

While the Australian Government Department of Health has contributed to the funding of this material, the information contained in it does not necessarily reflect the views of the Australian Government and is not advice that is provided, or information that is endorsed, by the Australian Government. The Australian Government is not responsible in negligence or otherwise for any injury, loss or damage however arising from the use of or reliance on the information provided herein.

MPCN acknowledges the peoples of the Kulin nation as the Traditional Owners of the land on which our work in the community takes place. We pay our respects to their Elders past and present. ©MPCN 2016.

Frame for this presentation

Some observations on the healthcare system including trends

How PHNs link in terms of role + levers

Mental health as a case example

Commissioning

Questions / Discussion

Our healthcare system(It’s actually a bunch of markets)

A number of disjointed interconnecting markets, with

various gatekeepers, places and intersects

Care is predominantly organised around providers rather than

consumers

Disconnection is incentivised through multiple and episodic-

based payment systems, decentralised policy governance

Governments are inconsistent in setting the overall frameworks in

which these markets operate

It’s not this elegant!!

Meta trendsin healthcare reform

Consumer directed, accountable care

• Resources follow the consumer in a joined up system

• (Real) evidence-based care

• Enrolment and ‘medical homes / neighbourhoods’

• Performance and outcomes focus

• Reformed models of care / financing (inc multiple payers)

Meta trendsin healthcare reform

Regional planning, funds pooling and capitation

• Better targeting and price control of services – especially in relation to uncapped MBS

• Removal of program silos and fragmentation

• Improved quality, performance and monitoring at the local level

• Social and community services link-up

Meta trendsin healthcare reform

Rapid translation / implementation of new technologies

• Digital health / personal digital health

• Medical therapeutic interventions (including new and / or individualised pharmacotherapies, treatments and procedures)

• Potential for shorter stay, higher increased and integrated care closer to the consumer

In that context…

www.nwmphn.org.au

Broad elements and activities that foster integration

Primary Health NetworksCore roles

General Practice / Primary Care supportCommissioning

OverlaysDriving efficiency and effectiveness ‘Managing the market’High level themes – Digital Health, Aged Care, Mental Health

etcCore stretch measures – cancer screening, potentially

preventable hospitalisations, mental health, immunisation

Primary Health NetworksFormally commenced operations 1 July 2015

2015 / 2016 transition year – contracts moved across, service delivery moved out, significant planning and preparation, high focus on stakeholder engagement

Major announcements in late 2015 – Federal Government announcements on resource shifting towards PHNs for Mental Health + new announcements on increased Alcohol and other Drug (AoD) treatment funding

Primary Health NetworksKey challenge is the reallocation of existing resources –

there are few new resources currently in the mix

Significant opportunities in the service (re)design space in order to refocus, retarget and integrate

As such, levers for change partially in the funding domain, but more strongly in planning and alignment domains – especially with State and Local Governments, Local Hospital Networks

Mental Health

Mental Health:challenges and opportunities

Responsibility for funding a range of programs from 1 July 2016, predominantly in the primary mental healthcare space

Major reform as the intent is to align services regionally, with a consumer centric focus

PHNs have responsibility to form regionally based ‘stepped care’ models and to develop regional suicide prevention plans

Mental Health:challenges and opportunities

Overlay• Vulnerable populations• Socio-demography• Incidence / Prevalence• Workforce• Other factors +++

Mental Health:challenges and opportunities

Rebalancing distribution – shifting resources based on location and needs

Overcoming significant ‘model drift’ compounded by lack of transparency and intervention efficacy – need for quality uplift in some service sectors

Only part of primary mental healthcare – does not include MBS, national suicide prevention infrastructure + some elements ‘protected’ for limited time periods (e.g headspace, Mental Health Nurse Initiative Program)

Shared spaces between the Commonwealth and States / Territories (eg. suicide prevention) – promising work underway

Stepping out the process:commissioning

It’s not just about ‘buying stuff’

Commissioning Framework

Commissioning:developing insight

www.nwmphn.org.au

www.nwmphn.org.au (soon)

Commissioning:market analysis

Phase 1: Priority work and priority populations

Commissioning:market complexity

Understanding and working with market sophistication / complexity (or lack thereof) is a key competency for PHNs

North Western Melbourne has likely one the most complex healthcare markets in Australia – ranging from large transnationals to solo practitioners domiciled within the catchment (includes Peak organisations, disease specific etc)

Devolved governance adds another layer of complexity in Victoria

Commissioning:engagement and co-design

Information sessions, planning meetings, surveys, conversations – large and small scale +++

Joined up planning with State Health, starting the conversation on purchasing alignment

Having some difficult conversations on service redesign, redistribution – driven by needs, evidence

and consumer voices

Models of care under construction – mental health as the first development piece

Commissioning:setting priorities

Commissioning:rolling timelines

Overlay• Government policy changes• Market readiness / disruption• Timing factors – 2015 / 2016 was

atypical, creating forward cycle issues

Q & A’s

Thank you!

Again, resources available at www.nwmphn.org.au