Western NSW Integrated Care Strategy

1. Western NSW Integrated Care Strategy To transform existing services into an integrated Western NSW system of care that is tailored to the needs of our rural and remote communities, improves access to care and health outcomes, focuses on closing the Aboriginal health gap Better Care…………Better Health…………Better Value

2. Every Day in Western NSW • 6 residents die: • 1 of the 6 deaths is tobacco related • 2 from potentially preventable conditions • 10 babies are born (2 are Aboriginal, 1 has a low birth weight,1 has a teenage mother) • 60 are admitted to a private hospital • 200 are admitted to a public hospital • 155 are <75 years old, 21 of them are children (5 Aboriginal) • 11 are potentially avoidable admissions • 3 for a mental health condition • 587 people present to an emergency department • 73% (427) conditions that are not urgent – a majority requiring nursing or GP intervention • 7% (39) serious illnesses/injuries requiring urgent treatment • 2,800 people consult their GP

3. Every Day in Western NSW Every resident pays $10.00 per day How would you spend your $10.00 each day to stay healthy ?? Daily Cost • Medicare (MBS) $334,510 • Pharmaceutical (PBS) $237,565 • Western NSW LHD $2,054,795 Average cost • GP attendance $41 • Emergency Presentation $707 • Day in acute hospital $1,375

4. Western NSW drivers • Rurality and remoteness • High proportion of Aboriginal population (11.1%) • The poor health outcomes experienced by the Aboriginal population • Growth in demand due to population ageing and increasing prevalence of long term conditions • High rate of admission • Multiple providers working in relative isolation • History of financial deficits • Patient experience, care co-ordination - suboptimal

5. Life expectancy at birth 2005-07

6. The Western NSW Strategic Health Services Plan and Integrated Care Strategy The Integrated Care Strategy • Provides the opportunity for the partners to accelerate the scale and pace of Strategic Health Services Plan implementation • Facilitates the transformational service redesign that is required • Mobilises primary care and LHD community to better manage care for higher complexity patients and families, and obtain better value from the available resources

7. Alignment with NSW State Plan & Integrated Care Strategy

8. Overarching program structure (1) • Partnership governance • Western NSW LHD accountability for delivery of the Strategy • Partnership governance established to support collaboration in delivery of the Western NSW Integrated Care Strategy • Built on existing bilateral partnerships between the partners, and close working relationships at strategic and operational levels • Positive discussions with Western NSW Aboriginal community controlled health services – via Bila Muuji Inc, to also join the Partnership • Clinical Leadership across primary and specialist care • Clinical governance, leadership and support • Initially medical evolving to multidisciplinary membership

9. Overarching program structure (2) • Health Intelligence Unit • Shared governance board with a strategic and evidence based focus • Analysis to support strategic and operational management, performance reporting, evaluation • Program Management discipline • Transformational change will be dependent on a change management approach supported by robust program management discipline • Identified deliverables, accountabilities and timelines

10. Local demonstrator sites Demonstrating redesign of delivery models across general practice, LHD primary & community health services, Aboriginal Medical Services, local rural hospital/MPS and specialist outpatient services

11. Local demonstrator site deliverables • Development of GP-led multidisciplinary models of care to manage high risk patients and those with chronic and complex illnesses (including diabetes, CVD, COPD, mental illness) • Development of integrated primary and secondary models of care that improve the patient experience and health outcomes (including maternal and child health opportunities) • Development of whole locality action to mobilse all health and social service providers • Risk stratification to identify target populations • Enrolment of identified population cohorts into integrated care plans • New business and funding models that incentivise delivery of integrated models of care • Establishing connectivity and shared care planning across multidisciplinary treatment providers and primary and secondary care services • Development of strategies that empower Aboriginal and high risk patients to participate in and manage their own and their families’ health and social needs • Development of flexible workforce strategies • Adoption of key performance indicators

12. Local demonstrator sites – work to date • Site visits to establish capacity and willingness to participate – objectives and redesign expectations • Development of minimum participation requirements and criteria • Identification of initiatives and implementation approaches – informed by international, national and local evidence and by learnings on a NZ Study Tour • Detailed scoping and planning, agreement on risk stratification criteria • Establishment of local leadership groups • Development of local needs profiles • Compilation of service directories • Signing of Memorandums of Understanding

13. District-wide initiatives Enabling district-wide implementation of an integrated approach to service delivery

14. Enablers and tools Identified enablers and tools are critical to the successful implementation and sustainability of new models of integrated care

15. Rationale for the WNSW Strategy • Expected benefits • Short and long term outcomes • Individual, population and system measures • District-wide benefits from ability to implement local demonstrator site initiatives at scale and pace • Ability to trial multiple different approaches in different communities (size, scope and type) • Ability to trial new funding mechanisms and incentives (including unique opportunities where GPs are also the hospital VMOs) • State-wide benefits from learnings achieved from multiple approaches • Program cost to reduce over 3 years to a sustainable service delivery model

16. Questions ?