Redesigning Canadian Health Care for the Age of Complex Care

1. Redesigning Canadian Health Care for the Age of Complex Care Queen’s Health Policy Change Conference Series May 16, 2014 Drs Tom Noseworthy & Tom Briggs

2. Better Quality, Better Outcomes, Better Value Complex High Needs Populations Alberta Health Services Costs Demographics Clusters Policy & practice considerations

3. The Goal Alberta to have a sustainable health system that creates the healthiest population and best health outcomes in Canada • One Health System: • 5 Zones • 4.2 million lives • 100,000 employees • 8,400 doctors • 13.4 B budget

4. Complex High Needs Populations • Population defined by costs attributed at patient level • $9.6B costs allocated • Top 5 % of population (total costs) identified • This populations consumes 66% of total costs • Health Service Areas examined for opportunities • Identified clusters using hierarchical cluster analyses • Clustering by demographics & chronic/episodic diseases

5. Total provincial CHN population 190,323 North 23,874 Calgary 65,091 Edmonton 59,575 South 16,417 Central 25,366 Percent female 57.5% Percent living alone 11.9% Provincial CHNP – Overall Demographics

6. Pop Frail Elderly 68,700 Complex Older Adults 60,202 Reproductive Health 36,495 Complex Infants/Toddlers 7,343 High Needs Young Adults 6,885 High Needs Children 6,365 High Needs Youth 4,333 High Level Cluster Overview

7. Financial Impact

8. Provincial example – Frail Elderly Profile Average age is 77.5 years 54% female 14% living alone 9% in LTC Percent with dementia 15.5% Percent at end-of-life >19% Days in hospital per year 20.1 Average visits to family doctor per year 13.5/year

9. Hypertension 72.5% Acute Musculoskeletal Diagnosis 39.3% Acute Respiratory Diseases/COPD 33.7% / 22.6% Osteoarthritis 31.8% Diabetes 28.5% Congestive Heart Failure 20.8% Neuromuscular/Neurological Diagnoses 20.7% Depressive and/or Other Psychoses 20.2% Frail Elderly Clinical Profile (Partial) Note: Data shows averages based on physician visit billing

10. Bringing appropriate care to the community • Strengthen community and primary health care • Develop innovative service delivery models • Increase service integration and accountability

11. Policy & Practice Considerations • Use an evidence-informed approach • Identify, measure & understand complex needs clusters • Clusters influence what care, where, by whom, funded how? • Place of care & provider funding aligned to pathways/models • Defined structures & processes for clinically led change • Care pathways & models of care necessary but insufficient • Individualized care plans • This is not new money & requires reallocation from acute care to the community