“Early       Beginnings”
            PHO Performance Programme
                      HINZ
                  16 March 2007
...
Background




Development of the Programme


 2002                   2003            2004         2005


 Referred Servic...
Points of difference
The Programme is characterised by:
•   Voluntarism – PHOs are free to join or withdraw;
•   Ownership...
What the Programme can offer
 (continued)

Member PHOs                   •   A source of direction to inform priority sett...
Objectives 2007 to 2009

Across the period 2007 to 2009, the Programme will become recognised by it stakeholders as:

    ...
Boundaries of Influence

 Underlying the Objectives set out in Part 3 of this document the boundaries of influence
 for th...
Overview of process
National
indicators are                                  Indicator          Targets
agreed,           ...
INDICATORS




     Current Set of Indicators


Focus                         Indicators                          Weightin...
Future indicator direction

   •   Continuing the strong focus on reducing inequalities

   •   Continue to improve access...
INFRASTRUCTURE




Infrastructure

• SQL Server Back End

• MS Access Front End

• Working Tables

• Reporting Modules

• ...
DATA SET




Data Flow
          Primary Source Data (Practice, Lab,
              Pharmacist, Screening Unit)


  Data re...
Levels of Data Access

                                                    Report Content

 Report Recipients             ...
Constraints of Future Data
Sets

• The information that will be sourced from PHOs will only be
  provided by the PHO to th...
• The first set of Six monthly and Annual
  targets are calculated for a PHO when its baseline
  report is generated;

• T...
Programme Reports delivered by the
   Programme to PHOs, DHBs and
   MOH
• Prerequisite Reports;
• Baseline reports (prior...
Performance payments

• Paid on a per enrolled person basis to PHOs

• 6 monthly payments for all indicators (except annua...
What has the PHO Performance
  Programme achieved so far?




Key Milestones and Achievements

• Went ‘live’ in January 20...
Take Home Messages
The PHO Performance Programme

• Uses a combination of sophisticated information
  sharing and financia...
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Early Beginnings - PHO Performance Programme

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Serena Curtis Lemuelu
District Health Boards New Zealand

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Early Beginnings - PHO Performance Programme

  1. 1. “Early Beginnings” PHO Performance Programme HINZ 16 March 2007 Purpose of the Presentation • Background • Strategic Direction • Programme Operation – Process – Indicators – Infrastructure – Dataset – Targets – Programme Reports – Payments • What has the PHO Performance Programme achieved so far? 1
  2. 2. Background Development of the Programme 2002 2003 2004 2005 Referred Services Referred Services Advisory Group Management Project Report PHO Performance Programme Clinical Clinical Performance Performance Indicators Group Indicators Project 2
  3. 3. Points of difference The Programme is characterised by: • Voluntarism – PHOs are free to join or withdraw; • Ownership – there is a strong sense of joint ownership between DHBs and PHOs; • Occupying neutral ground – the Programme sits between DHBs and PHOs, with management provided independently by DHBNZ; • Nimbleness – the Programme is able to adapt and change quickly; • Responsiveness - the Programme has the technical capacity to set PHO-specific targets, and also to establish district-specific indicators to support individual DHB initiatives; • Sharing comparative information – the Programme extends the power of provider- specific information by making available information that compares performance between providers; and • Providing financial incentives - the Programme further extends the power of information by the provision of financial incentives where appropriate. What the Programme can offer? Identity of customer: Nature of benefits offered Minister and Ministry of Health • An adaptable vehicle through which they may implement strategies (i.e. an enabler) • A source of high level DHB performance information • A source of high level PHO performance information • A tool for which monitoring and measurement programmes can utilise DHBs • An adaptable vehicle through which they may implement strategies (i.e. an enabler) • A source of information to enable comparative performance nationally • A source of high level PHO performance information • A source for obtaining relevant health sector information from • A tool for which monitoring and measurement programmes can utilise 3
  4. 4. What the Programme can offer (continued) Member PHOs • A source of direction to inform priority setting • A source of information to enable comparative performance across the region and nationally • A source of PHO practice and provider performance information • A source of funding • A source for obtaining relevant health sector information from PMS software vendors • Access to emerging sector priorities that will inform PMS product development • Consistent implementation of standardised data sets Enrolled persons • Assurance of continual improvements in the quality of the primary health care they receive. Strategic Direction 4
  5. 5. Objectives 2007 to 2009 Across the period 2007 to 2009, the Programme will become recognised by it stakeholders as: 1. A trusted information source for stakeholders who require access to information about the performance of primary care to assist their pursuit of health gain for enrolled populations. 2. A world-class Centre of Expertise in the design, implementation and operation of systems that use information, coupled where appropriate with financial incentives, to secure improvements in the performance of health sector providers. 3. A significant contributor to overall gains in health status that arise from: • improved access to primary care services; • improved primary care management of chronic disease ; and • reduction in current inequalities in health outcomes. Strategic Positioning Primary healthcare providers face a barrage of programmes and activities that seek to influence their behaviour. Those programmes and activities may: • be complementary (e.g. NSU, BPAC and the demand side activities of PHARMAC), • potentially overlap (e.g. the Get Checked programme) • potentially be in conflict (e.g. the activities of the pharmaceutical industry) We will: • Encourage those with responsibility for overlapping activities or programmes to utilise the Programme as their enabler; • Maintain strong partnerships with those with responsibility for complementary activities or programmes; and • Seek to become a predominant information portal for PHOs and DHBs/The Ministry of Health. 5
  6. 6. Boundaries of Influence Underlying the Objectives set out in Part 3 of this document the boundaries of influence for the Programme throughout 2007 – 2009 will relate directly and solely to health gain. i.e.: – improvements in access to primary care, – improvement in the primary care management of chronic disease, and – reductions in current inequalities in health outcomes. Beyond 2009 the boundaries of influence of the Programme could be expanded to include other aspects of primary care provider performance e.g. efficiency, workforce development or accountability. Programme Operation 6
  7. 7. Overview of process National indicators are Indicator Targets agreed, Baseline identified developed and values and agreed implemented reported in Performance to PHO Plan Indicator National targets Performance Baseline data are agreed, measurement extracted from developed and period data sources implemented commences PHO meets the Programme prerequisites and Performance Performance period data confirms that they payment extracted & measured against would like to join Made to PHOs agreed targets the programme Reports Targets provided reviewed/ to PHOs, readjusted for DHBs next performance and MOH period Looking forward: Indicator pipeline existing indicator review In Indicator Baseline Target contract, Definition data setting Payment Rationale collected Value Indication of timeframe 1-2 years from start to end 7
  8. 8. INDICATORS Current Set of Indicators Focus Indicators Weighting Prevent infectious diseases Flu & immunisation rates 15% Early detection of cancer Cervical & breast screening rates 30% Resource stewardship Evidence based Pharms & labs 45% utilisation Reduce disparities Rates for high need cf total pop 3.33% Internal processes NHI coverage, performance plan 6.66% delivery Chronic disease management Nil ... 0% 8
  9. 9. Future indicator direction • Continuing the strong focus on reducing inequalities • Continue to improve access • Enhance the focus on chronic disease management – Risk factors – Early detection – Strengthening self management – Increasing use of evidence based guidelines Changes to Indicator Set MODIFICATIONS FOR 1 JULY 2007 Age appropriate vaccinations for two year olds – Add a financial weighting Breast screening recorded in the last 2 years (Total Population) Information only Measurement of Acute phase response Information only Investigation of thyroid function ratio Information only Achievement of PHO performance plan objectives Information only Utilisation by high need enrolees – GP Consults - Add Nurse Consults From 1 July 2007 to 31 December 2007 apply a financial component to the development of a Cardiovascular Disease and Diabetes implementation Plan. 9
  10. 10. INFRASTRUCTURE Infrastructure • SQL Server Back End • MS Access Front End • Working Tables • Reporting Modules • Web Based Interaction 10
  11. 11. DATA SET Data Flow Primary Source Data (Practice, Lab, Pharmacist, Screening Unit) Data repository – Pharms & Lab Warehouse (NZHIS), HealthPAC, PHO, National Screening Unit Extracts of information to Programme Reporting Database Calculation of indicator values Generation of programme reports and distribution 11
  12. 12. Levels of Data Access Report Content Report Recipients Practitioner Practice PHO DHB National PHOs Y Y Y Y Y DHBs Y (anon) Y Y Y Ministry of Health Y Y Y Public Y Y Y anon = encrypted information Data Requirements CURRENT FUTURE • Data accessed from National • Data accessed from PMS driven Sources and some PMS driven reports and some National reports Sources – Breast and Cervical Screening – – Breast and Cervical Screening – National Screening Unit National Screening Unit – CBF Register and Flu – – CBF Register and Flu – HealthPAC HealthPAC – Provider Lists, Service Utilisation – Provider Lists, Service Utilisation and Immunisation, CVD, Diabetes, and Immunisation – PHOs Smoking Status – PHOs – Pharmaceutical and Laboratory – – Pharmaceutical and Laboratory – NZHIS Warehouses NZHIS Warehouses – CVD Plan - DHB 12
  13. 13. Constraints of Future Data Sets • The information that will be sourced from PHOs will only be provided by the PHO to the DHB and MOH at a PHO aggregate level. This means that the Programme will no longer be able to report on: – Provider Level performance information; – Practice Level performance information; Important to note that only PHOs will be able to receive the practice and provider level information that relates to the PHO aggregated values TARGETS 13
  14. 14. • The first set of Six monthly and Annual targets are calculated for a PHO when its baseline report is generated; • The targets are reviewed after a performance period; • A PHO’s target depends on its baseline values – not all PHOs will have the same target achievement values; • The targets are agreed between the DHB and PHO; • A performance payment to a PHO depends on its achievement towards their target. PROGRAMME REPORTS 14
  15. 15. Programme Reports delivered by the Programme to PHOs, DHBs and MOH • Prerequisite Reports; • Baseline reports (prior to entry into the programme); • Interim reports – (between the baseline and 1st progress report); • Progress reports; • Performance reports and Payment scorecards; and • Public reports – PHO level available after the PHO has been in the programme for 15 months PAYMENT PROCESS 15
  16. 16. Performance payments • Paid on a per enrolled person basis to PHOs • 6 monthly payments for all indicators (except annual indicators) – approx 4 months after the end of the measurement period • Actual payment depends on progress towards agreed targets • Partial payment for partial achievement • 25% guaranteed minimum payment for PHOs that commence in the Programme in 2006 and 2007. Use of Performance Payments • PHO discretion within national guidelines and as per Performance Plan • Guidelines are: – Extending health programmes or introducing new ones – Extending or introducing quality initiatives – Investing in CQI infrastructure – Rewarding practices for the effort required to improve performance – Funding professional development 16
  17. 17. What has the PHO Performance Programme achieved so far? Key Milestones and Achievements • Went ‘live’ in January 2006. • PHO participation is voluntary (all 81 PHOs have chosen to join - 77 current, 4 joining July 07) • All Programme reports (excluding the Public Report) have been developed • 1st Performance Period in October 2006, averaged 81% of the maximum possible payments • Overall significant progress in RSM indicators • Consultation on 2nd set of performance indicators has been completed (12 Feb 2007). 17
  18. 18. Take Home Messages The PHO Performance Programme • Uses a combination of sophisticated information sharing and financial rewards to assist PHOs to achieve gains in health status for their populations; • Has a set of unique characteristics that give it an edge over other primary care programmes and initiatives; • Is an enabler to Government’s vision for the health of New Zealanders as set out in the Primary Health Care Strategy; • Is uniquely placed to assist the Ministry, DHBs, PHOs and others to improve primary care performance. 18

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