Associate Professor Christopher Carter from Melbourne Primary Care Network covers the following: - Priorities for Primary Health Networks (PHN) - Broader changes to the PHN - Affecting change in primary health through PHN’s

1. Russell Kennedy NFP Seminar:
Strategic challenges facing primary health
from a not-for-profit perspective
24 August 2016
Michael Gorton AM @GortonM
@RussellKennedy_

2. Primary Health Networks
Current landscape, opportunities
and challenges
24 August 2016
While the Australian Government Department of Health has contributed to the funding of this material, the information contained in it does not necessarily reflect the views of the
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MPCN acknowledges the peoples of the Kulin nation as the Traditional Owners of the land on which our work in the community takes place.
We pay our respects to their Elders past and present. ©MPCN 2016.

3. Frame for this presentation
Some observations on the healthcare system including trends
How PHNs link in terms of role + levers
Mental health as a case example
Commissioning
Questions / Discussion

4. Our healthcare system(It’s actually a bunch of markets)
A number of disjointed
interconnecting markets, with
various gatekeepers, places and
intersects
Care is predominantly organised
around providers rather than
consumers
Disconnection is incentivised
through multiple and episodic-
based payment systems,
decentralised policy governance
Governments are inconsistent in
setting the overall frameworks in
which these markets operate
It’s not this elegant!!

5. Meta trends
in healthcare reform
Consumer directed, accountable care
• Resources follow the consumer in a joined up system
• (Real) evidence-based care
• Enrolment and ‘medical homes / neighbourhoods’
• Performance and outcomes focus
• Reformed models of care / financing (inc multiple payers)

6. Meta trends
in healthcare reform
Regional planning, funds pooling and capitation
• Better targeting and price control of services – especially in
relation to uncapped MBS
• Removal of program silos and fragmentation
• Improved quality, performance and monitoring at the local
level
• Social and community services link-up

7. Meta trends
in healthcare reform
Rapid translation / implementation of new technologies
• Digital health / personal digital health
• Medical therapeutic interventions (including new and / or
individualised pharmacotherapies, treatments and
procedures)
• Potential for shorter stay, higher increased and integrated
care closer to the consumer

8. In that context…
www.nwmphn.org.au
Broad elements and activities that foster integration

9. Primary Health Networks
Core roles
 General Practice / Primary Care support
 Commissioning
Overlays
 Driving efficiency and effectiveness
 ‘Managing the market’
 High level themes – Digital Health, Aged Care, Mental Health
etc
 Core stretch measures – cancer screening, potentially
preventable hospitalisations, mental health, immunisation

10. Primary Health Networks
 Formally commenced operations 1 July 2015
 2015 / 2016 transition year – contracts moved across,
service delivery moved out, significant planning and
preparation, high focus on stakeholder engagement
 Major announcements in late 2015 – Federal Government
announcements on resource shifting towards PHNs for
Mental Health + new announcements on increased Alcohol
and other Drug (AoD) treatment funding

11. Primary Health Networks
 Key challenge is the reallocation of existing resources –
there are few new resources currently in the mix
 Significant opportunities in the service (re)design space in
order to refocus, retarget and integrate
 As such, levers for change partially in the funding domain,
but more strongly in planning and alignment domains –
especially with State and Local Governments, Local Hospital
Networks
Mental Health

12. Mental Health:
challenges and opportunities
 Responsibility for funding a range of programs from 1 July
2016, predominantly in the primary mental healthcare
space
 Major reform as the intent is to align services regionally,
with a consumer centric focus
 PHNs have responsibility to form regionally based ‘stepped
care’ models and to develop regional suicide prevention
plans

13. Mental Health:
challenges and opportunities
Overlay
• Vulnerable populations
• Socio-demography
• Incidence / Prevalence
• Workforce
• Other factors +++

14. Mental Health:
challenges and opportunities
 Rebalancing distribution – shifting resources based on location
and needs
 Overcoming significant ‘model drift’ compounded by lack of
transparency and intervention efficacy – need for quality uplift in
some service sectors
 Only part of primary mental healthcare – does not include MBS,
national suicide prevention infrastructure + some elements
‘protected’ for limited time periods (e.g headspace, Mental
Health Nurse Initiative Program)
 Shared spaces between the Commonwealth and States /
Territories (eg. suicide prevention) – promising work underway

15. Stepping out the process:
commissioning
It’s not just about ‘buying stuff’

16. Commissioning Framework

17. Commissioning:
developing insight
www.nwmphn.org.au
www.nwmphn.org.au (soon)

18. Commissioning:
market analysis
Phase 1: Priority work and priority populations

19. Commissioning:
market complexity
 Understanding and working with market sophistication /
complexity (or lack thereof) is a key competency for PHNs
 North Western Melbourne has likely one the most complex
healthcare markets in Australia – ranging from large
transnationals to solo practitioners domiciled within the
catchment (includes Peak organisations, disease specific etc)
 Devolved governance adds another layer of complexity in
Victoria

20. Commissioning:
engagement and co-design
Information sessions, planning meetings, surveys,
conversations – large and small scale +++
Joined up planning with State Health, starting the
conversation on purchasing alignment
Having some difficult conversations on service
redesign, redistribution – driven by needs, evidence
and consumer voices
Models of care under construction – mental health as
the first development piece

21. Commissioning:
setting priorities

22. Commissioning:
rolling timelines
Overlay
• Government policy changes
• Market readiness / disruption
• Timing factors – 2015 / 2016 was
atypical, creating forward cycle
issues

23. Q & A’s
Thank you!
Again, resources available at www.nwmphn.org.au