1. What is a Potentially Preventable Hospitalisation? Is this why we integrate – to reduce PPHs?

2. Transparency/Connectivity and Economic Performance www.imf.org/external/pubs/ft/fandd/2013/12/brandao.htm

3. OECD Observer A basic message has emerged: investments in health and the design of health financing policies should be addressed in terms of the interaction between health and the economy. Just as growth, income, investment and employment are a function of the performance and quality of the economic system, its regulatory frameworks, trade policies, social capital and labour markets, etc, so health conditions (mortality, morbidity, disability) depend not just on standards of living, but on the actual performance of health systems themselves.

4. Well-performing health systems make Europe 'politically stable'

5. Leutz’s 5 Laws of Integrated Care 1.You can’t integrate all of the services for all of the people 2.Integration costs before it pays 3.Your integration is my fragmentation 4.You can’t integrate a square peg in a round hole 5.The one who integrates calls the tune

6. Multi morbidity increases with age Barnett, Mercer, Norbury, Watt, Wyke, Guthrie: Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study; Lancet 380:9836, 7-12 July 2012, pp. 37-43

7. Multi morbidity correlated with socio-economic status Barnett, Mercer, Norbury, Watt, Wyke, Guthrie: Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study; Lancet 380:9836, 7-12 July 2012, pp. 37-43

8. Do we integrate simply to address avoidable admissions? Or are we building a connected, transparent, navigable health system Are we building a health system that is more equitable and accessible Are we building health system that contributes to the overall well being and capability of our community?

12. Raj Verma Director, Clinical Program Design & Implementation Agency for Clinical Innovation Patient reported outcome and experience measures – PROM and PREM 6 November 2014

13. PROM Short term Feedback on immediate individual care PROM Long term Feedback on longer term clinical outcomes PREM Short term Feedback on current integration of care PREM Long term Feedback on system of integrated care

14. PROM Short term Feedback on immediate individual care PROM Long term Feedback on longer term clinical outcomes PREM Short term Feedback on current integration of care PREM Long term Feedback on system of integrated care Most PROM work internationally focussed here - mainly surgical procedure outcomes (eg knee replacement, cataracts). Clinical and functional outcomes for the patient.

15. PROM Short term Feedback on immediate individual care PROM Long term Feedback on longer term clinical outcomes PREM Short term Feedback on current integration of care PREM Long term Feedback on system of integrated care This is the emerging area of PROMs (or PRMs), and CI are running a pilot now, including an IT system that feeds in to Mosaic, and has tablet device input. Immediate clinical care issues – incl anxiety, confidence, pain, etc.

16. PROM Short term Feedback on immediate individual care PROM Long term Feedback on longer term clinical outcomes PREM Short term Feedback on current integration of care PREM Long term Feedback on system of integrated care ACI currently has PETs that could capture this, but not linked to PROM or to eMR.

17. PROM Short term Feedback on immediate individual care PROM Long term Feedback on longer term clinical outcomes PREM Short term Feedback on current integration of care PREM Long term Feedback on system of integrated care This will feedback at the system level, but not be as high level or extensive as the NSW Patient Survey. One option for anonymous feedback is Patient Opinion

18. Innovating for Integration Making Integrated Care Happen at Scale and Pace 16 Lessons from Experience

19. Soft Diplomacy vs Structure Narrative Vision Leadership Priorities Trust Time and Space Shared Governance Pooled Funding Shared Information and Data Systems

20. Heroic Leadership vs Structure

22. How Have We Got Here? Relationships Trust Kumbaya

23. My version Innovation TrustSystemsLearnAdapt

24. Move from Relationships to Systems And build your systems to replicate and reinforce your relationships.