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Advancing the Science of Transformation in Integrated Primary Care: Advancing the Science of Transformation in Integrated Primary Care:

Advancing the Science of Transformation in Integrated Primary Care: - PowerPoint Presentation

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Advancing the Science of Transformation in Integrated Primary Care: - PPT Presentation

Informing Options for Scalingup Innovation   Session 3 Addressing health equity and disparities across diverse communities Policy implications amp Discussion Jonathan Foley Westcott Partners LLC ID: 781569

care health funding primary health care primary funding zealand services www community disparities http impact based disparity delivery approach

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Slide1

Advancing the Science of Transformation in Integrated Primary Care:Informing Options for Scaling-up Innovation  

Session 3:

Addressing health equity and disparities across diverse communities: Policy implications & Discussion

Jonathan Foley, Westcott Partners LLC

Slide2

PurposeDescribe the use of certain indicators of need in a primary health care funding formula in the context of a comprehensive reform of New Zealand’s primary health care system; and, Assess the impact of this funding approach on primary health care delivery systems and populations served by those systemsComment on the implications of New Zealand’s experience to efforts to address social determinants in the United States

Slide3

ContextPrimary Health Care Strategy – comprehensive reform of the way primary health care was delivered, financed, and governed.Specific objectives included:Making primary health care affordable with co-pays reduced or, in some cases, eliminated

Increasing utilization of needed services, especially preventive services and health screenings

Promoting better coordination of care

Reducing health inequalities through new models of care

Primary Health Organizations (PHOs) – GP practices and clinics aggregated in local areas to be focal point. Non-profit with community representation.

Needs-based population funding formulae – means for allocating government subsidy; incorporates ethnicity and area deprivation index

Slide4

Health disparities

New Zealand Ministry of Health, “Decades of Disparity: Ethnic Mortality Trends in New Zealand 1980–1999,” 2003

http://www.moh.govt.nz/notebook/nbbooks.nsf/0/37A7ABB191191FB9CC256DDA00064211/$file/EthnicMortalityTrends.pdf

New Zealand Ministry of Health, “Decades of Disparity II: Socioeconomic mortality trends in New Zealand, 1981-1999,” 2005.

http://www.rangahau.co.nz/assets//decades_disparity/disparities_report2.pdf

, income is weighted by ethnicity.

Slide5

Health Disparities (cont.)

Disease/ condition

Gender

Maori

Pacific

European/

other

Asian

Heart disease

Male

13.6

5.99.48.1Female10.67.98.54.6StrokeMale2.5n/a2.0n/aFemale2.8n/a1.4n/aDiabetesMale9.58.13.48.1Female6.711.92.48.7AsthmaMale21.69.420.86.3Female27.210.825.98.7COPDMale6.0n/a4.6n/aFemale6.3n/a5.9n/aHigh blood pressureMale23.716.217.614.4Female23.918.219.213.1High cholesterolMale15.99.514.613.4Female12.011.113.212.3ObesityMale29.038.018.04.3Female27.547.819.86.9Current SmokerMale42.934.821.318.9Female51.131.619.93.6Seen GP in last yearMale67.875.177.763.8Female82.583.787.073.8MammogramFemale69.057.176.955.6Cervical screenFemale72.854.477.543.1

Percent of NZ Health Survey (2002/2003) respondents answering positively to selected questions (age standardized)

New Zealand Ministry of Health, “A Portrait of Health: Key results of the 2002/03 New Zealand Health Survey,” 2004

Http://www.moh.govt.nz

Slide6

For the most recent version, see “NZDep2013 Index of Deprivation,” June Atkinson, Clare Salmond, and Peter Crampton, published by the Department of Public Health, University of Otago, Wellington, May, 2014.

http://www.otago.ac.nz/wellington/otago069936.pdf

Slide7

Health equity innovationFunding formulae allocate more money to PHOs with greater concentrations of Maori, Pacific Islanders, and most deprived enrolleesPHOs use funding to:Lower fees for enrolleesDevelop outreach programs that improve access – e.g., transportation services, nurse clinics on marae or remote locations, community health workers

Run health promotion services and campaigns that influence health behaviors – e.g., smoking cessation, safe driving, healthy eating

Connected to mainstream medical care through PHO

Slide8

Pacific women as keys to family health

Culturally appropriate services

Community based health promotion

Slide9

Evaluation of impact

Slide10

Lessons LearnedRapid implementation driven by political momentum enabled broad-based reform across the country;DHBs and general practitioners do not have as much ownership of strategy because of rapid implementation;Fee reductions limited by soft regulatory approach and GP resistance;

Tensions between universal and targeted approaches;

Not enough attention to planning and evaluating service delivery innovations aimed at reducing inequalities;

Impact of service delivery innovations dependent on capacity and expertise of local practitioners.

Slide11

Primary Health Care Funding Path

Rapid Implementation

Slide12

Implications for the United StatesSeveral versions of area deprivation indeces available – strong correlation with health outcomes; use readily available Census data

Existing and promising programs to address health inequalities through focus on social risk factors:

Community health centers – 1200 centers, 25 million served

Patient Centered Medical Home – comprehensive, coordinated, team approach

Accountable Health Communities – 44 communities

IMPACT Act – possible adjustments to Medicare payments based on social risk factors

Scaling up depends on:

Clearer understanding of what works

Local capacity and expertise to undertake new models of careAppropriate funding

Ongoing accountability mechanisms, evaluation and feedback

Political will