Serena Curtis Lemuelu District Health Boards New Zealand

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?
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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
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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
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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
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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.
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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
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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
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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%
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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.
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10. INFRASTRUCTURE
Infrastructure
• SQL Server Back End
• MS Access Front End
• Working Tables
• Reporting Modules
• Web Based Interaction
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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
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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
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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
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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
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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
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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
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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).
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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.
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