Enabling quality in primary care

The purchaser role

ACC’s Primary Care Programme

• ACC purchasing of primary care is changing• Current purchasing methods (fee for service)

are passive and enable few incentives for greater quality or innovation

• Primary care chief executives met with ACC last year to agree a programme of change

• Pilots will test opportunities for improvement

New purchasing framework

• The ACC purchasing framework will define the type of change:• Relationship based

• Mutually beneficial• Cooperative, based on agreed outcomes, service

development and risk sharing• Value driven

• Based on both cost and quality• Accountability/Development

• Provider monitoring and evaluation• Performance feedback

• Timeliness• Every day off work means payment for income

replacement

Purchasers can play a major role in the search for quality • Four step cycle

Two examples

• ACC has recently worked with anaesthetists to co-design a pre-operation assessment process to improve quality.

• Problem raised in ACC/Anaesthetists liaison meetings

• Patient co-morbidities, medications, allergies, lifestyle issues relevant information for improving quality of service

• Questionnaire use now mandatory for ACC-contracted anaesthetists

Time off Work Certification

• ACC has been working with Lake Taupo PHO to review certification patterns by local general practitioners and to design a way to improve them

• Use of clinical evidence about benefits of recovery of work, support for liaison with employers and performance based contract with incentives for quality practice

Clinical Evidence

• COHE Initiative Washington State – 2004

• 33% less likely to miss work

• Systematic Review of Quantitative Literature – 2005 Canada

• work based RTW interventions can reduce work disability duration

Clinical evidence

• Vocational Rehabilitation – What Works, for Whom, and When?Waddell, Burton, Kendall 2008:

• “The advice and management given in primary care has a major and lasting impact on the individual’s (and their family’s and employer’s) beliefs about the health condition and how it should be managed”

General Practice

General practitioners:• Play a key role in advising and supporting

patients about return to work

• Need to understand their patients’ work situation

• Should appreciate that return to work is an important outcome for clinical management

Data-based targets

Data based targets

Monitoring and evaluation

• New focus on the monitoring of provider performance through data collection and analysis

• ACC has used payment data in the past• Not fit for purpose• Designing monitoring frameworks with providers in

the future will enable ACC to better provide feedback and support quality improvement in general practice