Enabling quality in primary care

1. Enabling quality in primary care The purchaser role

2. ACC’s Primary Care Programme • ACC purchasing of primary care is changing • Current purchasing methods (fee for service) are passive and enable few incentives for greater quality or innovation • Primary care chief executives met with ACC last year to agree a programme of change • Pilots will test opportunities for improvement

3. New purchasing framework • The ACC purchasing framework will define the type of change: • Relationship based • Mutually beneficial • Cooperative, based on agreed outcomes, service development and risk sharing • Value driven • Based on both cost and quality • Accountability/Development • Provider monitoring and evaluation • Performance feedback • Timeliness • Every day off work means payment for income replacement

4. Purchasers can play a major role in the search for quality • Four step cycle

5. Two examples • ACC has recently worked with anaesthetists to co-design a pre-operation assessment process to improve quality. • Problem raised in ACC/Anaesthetists liaison meetings • Patient co-morbidities, medications, allergies, lifestyle issues relevant information for improving quality of service • Questionnaire use now mandatory for ACC-contracted anaesthetists

6. Time off Work Certification • ACC has been working with Lake Taupo PHO to review certification patterns by local general practitioners and to design a way to improve them • Use of clinical evidence about benefits of recovery of work, support for liaison with employers and performance based contract with incentives for quality practice

7. Clinical Evidence • COHE Initiative Washington State – 2004 • 33% less likely to miss work • Systematic Review of Quantitative Literature – 2005 Canada • work based RTW interventions can reduce work disability duration

8. Clinical evidence • Vocational Rehabilitation – What Works, for Whom, and When?Waddell, Burton, Kendall 2008: • “The advice and management given in primary care has a major and lasting impact on the individual’s (and their family’s and employer’s) beliefs about the health condition and how it should be managed”

9. General Practice General practitioners: • Play a key role in advising and supporting patients about return to work • Need to understand their patients’ work situation • Should appreciate that return to work is an important outcome for clinical management

10. Data-based targets

11. Data based targets

12. Monitoring and evaluation • New focus on the monitoring of provider performance through data collection and analysis • ACC has used payment data in the past • Not fit for purpose • Designing monitoring frameworks with providers in the future will enable ACC to better provide feedback and support quality improvement in general practice