Lynelle Hales, South Eastern Sydney Medicare Local - Medicare Locals: Planning and Coordinating Care


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Lynelle Hales, CEO, South Eastern Sydney Medicare Local delivered this presentation at the 15th Annual Health Congress 2014. This event brings together thought leaders and leading practitioners from across the Australian health system to consider the challenges, implications and future directions for health reform.

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Lynelle Hales, South Eastern Sydney Medicare Local - Medicare Locals: Planning and Coordinating Care

  1. 1. Lynelle Hales CEO South Eastern Sydney Medicare Local Medicare Locals: Planning and Coordinating Primary Health Care
  2. 2. Planning and Coordinating Primary Health Care (PHC) • Set the Context: PHC • Role and Potential of Medicare Locals • Examples in South Eastern Sydney
  3. 3. Australian Health System • National Health and Hospital Reform Commission, June 2009 • National Preventative Health Strategy, June 2009 • National Primary Care Strategy, 2010 • Australia’s Health 2012
  4. 4. What the Reports Say: • Primary health care is typically the first health service visited by patients with a health concern – Includes most services not provided by hospitals – Involves a wide range of professions, such as GPs, pharmacists, ambulances, community health workers, Aboriginal health workers, practice nurses and dentists. • The service delivery, funding and governance arrangements for primary health care continue to be complex
  5. 5. What the Reports Say: • The majority of health-care services are provided through the primary health-care system, including –130 million services subsidised by the MBS –200 million prescriptions subsidised by the PBS and RPBS. • In 2010–11, 39% of hospital emergency department presentations were for GP-type consultations • Private health insurers offered rebates for a range of allied health services, including –28.4 million dental services –8.6 million physiotherapy services
  6. 6. Historic Patient Journey
  7. 7. Chronic Disease Management Barnett et al. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. The Lancet, Volume 380, Issue 9836, Pages 37 - 43, 7 July 2012. Available at:
  8. 8. Navigating the Health System
  9. 9. Navigating the health system... • Increasing complexity of health and social care • Funding of healthcare changing • Need to work differently and in partnership • Coordination of Care an essential component of care provision • Increasing need for health intelligence: – Health literacy – Navigation tools: Diagnostic / treatment Providers, Services Challenge or Opportunity...
  10. 10. Role for Medicare Locals Medicare Locals are primary health care organisations established to coordinate primary health care delivery and tackle local health care needs and service gaps. They have been established to: • Drive improvements in primary health care • Ensure that services are tailored to meet the needs of local communities • Improve coordination and integration of primary health care in local communities • Address service gaps • Make it easier for consumers to navigate their local health care system
  11. 11. Role of Medicare Locals in Primary Health Care Planning Coordinating Care Delivering Care • Population • Workforce • Health Partnerships • Health Intelligence • Proactive Care • Areas of Shortage
  12. 12. South Eastern Sydney Medicare Local Officially launched on 1st July 2012 SESML region consists of four local Government areas : Sutherland Shire, Hurstville, Kogarah and Rockdale, comprising 400 square kilometres Total population of the region is 442,864 (2011 Census) with a higher than average representation of those aged 65+ 3 Public and 8 Private hospitals within SESML 196 General Practices, 492 GPs, 105 Practice Nurses 1000 Allied and Community Health Professionals, including 120 pharmacies 60 Residential Aged Care Facilities 3 Aboriginal specific services One of 2 Medicare Locals in the SESLHD
  13. 13. Vision Strategic PriorityAreas Initiatives 1 2 3 Developed a concise description of the strategic change programme that the SESML is aiming to achieve in next two years Agreed priority areas and actions to drive achievement of the vision – including improved health gains, reduced inequalities and improved quality of care Established the team to deliver the strategic priority areas in the context of the strategic programme of change and impact on health outcomes SESML Establishment
  14. 14. ML
  15. 15. Planning • Undertaken a comprehensive needs assessment , highlighting key priority areas within South Eastern Sydney Medicare Local: – Improvements in proactive care of chronic and preventable diseases – Mental health services – particularly targeting increased support for co-morbidities – both health and drug and alcohol – Aged Care services – improving access to services particularly through better coordination between services. – Navigation: strong call for improved health intelligence, through health literacy tools, diagnostic and treatment tools and navigation tools for services and support at different stages of the patient journey • Workforce Mapping and Strategy Development: looking at different ways of working (PHC networks, virtual integration, HealthOne)
  16. 16. Practice Support Program • Education programs (small groups and CPD events for both GPs and Allied Health) • Chronic Disease Management initiatives led by practices • Ehealth: SESML has undertaken a wide range of activities to assist in increasing awareness and use of the national Personally Controlled eHealth Record System in the region. • Quality Improvement in clinical practice including roll out PenCAT tool to improve data quality and supporting immunisation and quality use of medicines • Practice Nurse support • Allied Health support – education and connectivity • Workforce planning and exploration of options to support provision and coordination of primary health care: e.g. Virtual integration, nurse led clinics
  17. 17. Coordinating Care through Effective Partnerships MLs LHN Community Services Understanding the role of individual organisations, where there are common interest and where unique role in supporting PHC
  18. 18. Strategic Collaboration • Eastern Sydney Medicare Local • South Eastern Sydney Medicare Local • South Eastern Sydney Local Health District – Including Sutherland and St George Hospitals, War Memorial Hospital, Calvary Health Care • St Vincent’s Hospital Network (Darlinghurst) • Sydney Children’s Hospital Network (Randwick) • UNSW Centre for Primary Health Care and Equity Agreed Partnership Principles Sharing information and interests Joint needs assessment and planning Sharing priorities and actions Governance Structure and Processes
  19. 19. Connecting Care: providing more effective health management for people aged 16 years and over with chronic diseases who are at high risk of unplanned hospital admission. • Care Coordination • Specialist Clinics • White Board meetings • Access and Referral Centre • Future work with the CCSS Program • Hospital Avoidance • Integrated care supporting GPs
  20. 20. Providing access to services for our younger population: two headspace Centres Led consortium of 10 to establish two headspace centres for young people : Miranda and Hurstville • GP Clinic • Sexual health clinic • Psychology Services(ATAPS) • Drug and Alcohol services
  21. 21. Partners in Recovery (PIR) has been designed to help improve the supports provided to people living with severe and persistent mental illness who have multiple support needs, by focusing on improving the response of the system to meet their needs. SESML led consortium of 15 – working together to improve pathways to accessing support and ensuring that the services supporting a person, are working together in a coordinated and recovery orientated way, meeting the full range of their support needs.
  22. 22. Access to Allied Health Services in Aged Care Program • Regional Medical Advisory Committee(RMAC) • Liaison with all RACFs in area • Strategic partnerships • Coordination of AHP • Education in RACFs • GP access into RACFs • Stepping on program and GPERS • Identify gaps: • Dementia/Palliative/HACC rep.
  23. 23. Improving Access to Primary Care After Hours Services through partnership • Two local GP run after hours clinics: Kareena and St George • Improved availability of home visiting services and universal access for RACFs. • Provision of incentives for increased opening hours and improving access to services after hours • Support and coordination for after hours service improvements including accreditation of after hours services and funding of practice nurse on weekend after hours.
  24. 24. ATAPS Through a hybrid model of directly employed psychologists and 40 contracted psychologists, SESML has increased access to mental health services through the ATAPS program facilitating 6,496 sessions of short-term psychological services over the last 18 months. • Group or individual treatment programs • Up to 12 “free” individual sessions with Allied Health Professional per calendar year with review by GP after each 6 sessions • Additional 6 sessions in exceptional circumstances • AHPs of various disciplines • Therapy: Psychological Therapy or Focussed Psychological Strategies predominantly Cognitive Behaviour Therapy based. During this last year, SESML has effectively introduced the ATAPS Clinical Governance Framework requirements with centralised triage and introduction of a Client Management System.
  25. 25. Closing the Gap Program • Working together to Close the Gap • Embedding Aboriginal and Torres Strait Islander health priorities across all PHC programs. • Indigenous Chronic Disease Package aims to achieve a reduction in the chronic diseases for Aboriginal and Torres Strait Islander people through support to the health sector and increasing access to health care • Indigenous Access to Mainstream Primary Care Program: improving access to culturally sensitive mainstream primary care services
  26. 26. In Summary: the Future of Primary Care • Need to work differently and in partnership • Need to become patient focused rather than disease focused • Coordination of Care is an essential component of care provision • Increasing need for health intelligence: Health literacy Navigation tools Improved data
  27. 27. In Summary: Role of Medicare Locals in PHC Planning Coordinating Care Delivering Care • Population • Workforce • Health Partnerships • Health Intelligence • Proactive Care • Areas of Shortage
  28. 28. The direction is clear. MLs have built a strong base to build from The work going forwards is fully focused on achieving maximum impact in primary health care There are great opportunities for us to work collaboratively with our communities to improve health care integration and outcomes. Thankyou.