1. Tasmania Medicare Local gratefully acknowledges the financial and other support of the Australian Government Department of Health Tasmanian Health Assistance Package Tasmanian Health Conference 26-27 July 2014 Presented by Phil Edmondson, CEO

2. Tasmanian Health Assistance Package - what’s happening and what’s still to come?

3. Funding and Resourcing $13.3 M over 3 years. 3 principal components to contract: –Health Risk Factors Project –Exercise Treatment Initiative (part of risk factors) –Social Determinants Activity THAP Element A Social Determinants of Health & Health Risk Factors

4. Social Determinants of Health The “causes of the causes” including poverty, poor housing, disrupted/under- education, poor literacy, inadequate access to nutritious food, inadequate transport. Project Approach Applying a place based approach to address the social determinants of health 9 communities with lowest SEIFA receiving $350,000 each over 2 years $50,000 for developing partnerships and detailed project plans, further $300,000 on submission of detailed plan and budget Capacity building to support partners to deliver projects effectively Rigorous evaluation to measure outputs, outcomes and whether this approach worked THAP Element A Social Determinants of Health & Health Risk Factors cont’d

5. Nine collaborative projects involving 43 partner organisations: community houses employment agencies schools (primary and secondary) TasTAFE local councils health, welfare and medical agencies child and family centres community cultural organisations community bank housing providers THAP Element A Social Determinants of Health & Health Risk Factors cont’d Capacity Building elements already delivered: Bridges Out of Poverty Evaluation strategies Partnering, governance, collective impact Contract management Social Determinants of Health

6. What is still to come Implementation phase of 9 community projects See fact sheets for individual project details Statewide capacity building activities including: Project management and support Best practice community engagement Project governance, strategic planning budgeting and advocacy training Asset mapping for community decision making Evaluation Bridges Out of Poverty THAP Element A Social Determinants of Health & Health Risk Factors cont’d

7. Health Risk Factors Five projects over three years: Smoking reduction to 15% by 2016 - $900,000 Poor nutrition, diet and obesity ( Healthy Food Access Tasmania) - $1,200,000 Exercise Treatment Initiative (Strength2Strength) - $2,500,000 Alcohol and smoking reduction in youth (#switchitround) - $420,000 Health literacy strategy for community practitioners - $300,000 THAP Element A Social Determinants of Health & Health Risk Factors cont’d

8. THAP Element A Social Determinants of Health & Health Risk Factors cont’d

9. THAP Element A Social Determinants of Health & Health Risk Factors cont’d

10. Health Risk Factors Exercise Treatment Initiative - North (June 2013 - June 2014) 384 referrals to date – those with high risk of hospitalisation Approx. 200 patients have now completed the program 100 are currently actively engaged with the program Data analysis on the first 2 cohorts shows similar improvements across most measures including waist circumference, both systolic and diastolic blood pressure, sit to stand test time, timed up and go test, walking distance and all quality of life scores (overall, mental and physical health). THAP Element A Social Determinants of Health & Health Risk Factors cont’d

11. What is still to come Exercise Treatment Initiative rolling out to North West Health Literacy implemented through TML and partner organisations to undertake audit and education sessions to increase partitioner capacity to create/impart “best practice” health information Alcohol and smoking - young people to be engaged in developing peer driven social media strategies Health Food Access Tasmania project rolling out small grants program to establish communities partnerships between retailers, growers and consumers. THAP Element A Social Determinants of Health & Health Risk Factors cont’d

12. Funding & Resourcing $35.2 Million over 3.5 years –$4.7 Million for Tasmanian HealthPathways –$30.5 Million for Care Coordination THAP Element B Care Co-ordination for People with Chronic Disease & Aged Care Clients

13. Funding Received $4.7 Million over three years to deliver a “system roadmap” of at least 130 pathways, including the key areas of cardiovascular diseases, diabetes, Chronic Obstructive Pulmonary Disease (COPD) and neurodegenerative conditions. $1.1 Million over three years for independent project evaluation. THAP Element B

14. Where it has already provided assistance 21 localised Tasmanian pathways for cardiology and other clinical areas, another 88 under active workgroup development. Human resources (TML) –Project management team (Leader, Manager, Support Officer) –6 part-time GP clinical leaders/editors across 3 regions –E-health support services Contractors (External) –Streamliners NZ: web development and technical writing service –THOs: participation/advice of clinical champions in each region, other specialist staff, access to data/information and support –KPMG independent evaluator THAP Element B cont’d

15. What is still to come Launch of live Tasmanian HealthPathways website Proposed 17 September 2014 Access for all Tasmanian clinicians to a password protected portal »Inclusive of ~40 pathways (plus resource pages) for cardiology, diabetes and others »90 pathways by June 2015 (likely to be over 150) »130 pathways by June 2016 (likely to be over 220) –Current work areas: respiratory (including COPD), Parkinson’s Disease, cognitive impairment/dementia, stroke/TIAs, immunisation –Future areas include: palliative care, orthopaedics, gasroenterology, ENT THAP Element B

16. What have we been doing with the Care Coordination funding? Implementation of Care Coordination Program (CCP) statewide using various models, sectors, multidisciplinary referral processes and access points. Funding to organisations already providing care coordination (CC) to increase their capacity. As at 30 June 2014 we have commissioned 17 organisations (11.65 FTE) providing unique needs based access through: –11 general practices (some multiple practices/sites –4 aged care facilities –2 community organisations Plus TML Regional Backup Team - 4.4 FTE providing: In-reach hospital model with acute sector referrals to TML program outreach services – Scottsdale and Georgetown Supporting acute sector and specialist outpatient services to increase their capacity to provide their specialist services and be the ‘link’ to general practice THAP Element B Care Co-ordination for People with Chronic Disease & Aged Care Clients

17. Where it has already provided assistance: Assisted 838 clients state-wide during the initial implementation phase Jan - June 2014 Average; funded orgs- 54 active pts/FTE over a 3-5 month period TML CC’s - 47 active clients/FTE Jan - Jun Rural collaboration models: Coverage of a region, especially in rural areas, accessible by all service providers through a multidisciplinary referral process in a small regional area Disease specific CC’s – Dementia related diseases, COPD and Motor Neurone Disease. Increased communication and collaboration with General Practice THAP Element B Care Co-ordination for People with Chronic Disease & Aged Care Clients cont’d

18. Care Coordination Services and Gaps As of July 2014

19. What is still to come Stage two rollout: July 2014 31 contracted organisations providing care coordination services (24.05 FTE) 19 General Practices, 5 ACFs, THO NW x 2, Community Orgs – 5 Aim - 150 clients/FTE in 12 months = 3600 clients over 12 month period. Workforce Development: Develop vocational training module – Care Coordination Provide Endorsed / accredited sector specific education and training Evaluation: comprehensive ongoing evaluation of program Sustainability: Working with individual organisations to review long term sustainability and modelling finances, health outcomes, and locally/region/sectoral integration Embed process THAP Element B Care Co-ordination for People with Chronic Disease & Aged Care Clients cont’d

20. What money was received is being spent $11.5M funding over 4 years. System redesign to improve people’s transition between the acute, primary and aged care sectors. Focus is on working with the existing system to do things differently. Critical elements: system integration, professional provider interactions, consumer engagement. Strong partnership approach: –Primary health care providers (general practice, nursing, allied health) –Aged and Community Services Tasmania –Tasmanian Health Organisations (THO) –Private hospital system –Consumer groups –Department of Health and Human Services THAP Element C Streamlined Care Pathways

21. Where it has already provided assistance Australian Primary Health Care Research Institute partnership to build the evidence base Talking Points – Best Practice Guidelines for Transition Care developed in partnership with key stakeholders Service redesign to improve complex care delivery in community based settings: –Kingborough/Huon Community Nursing – Future Directions in Primary Health Care (THO-South) –Launceston Community Health Nursing – Better Access to Community Care (THO-North) Shared Electronic Discharge Summary and Outpatient Clinic Summary (THO – statewide) THAP Element C Streamlined Care Pathways cont’d

22. What is still to come Targeted initiatives working with the existing service delivery system to streamline and improve transition of care. System Integration: –Talking Points Guidelines across acute, primary and aged care –Uniform communication protocols and transition decision making tools, including electronic systems –Develop post hospital pathways – condition specific and co-morbidity (linked with Tasmanian Health Pathways) Professional Provider Interactions: –Continue service re-design initiatives (e.g. community nursing) –Demonstrate integrated community based models in rural areas –Develop community based ‘in-reach’ models to the acute care system to assist with timely discharge –Workforce development strategy Consumer Engagement: –Consumer resources to support improved understanding and self-management of care transition. THAP Element C Streamlined Care Pathways cont’d

23. Social Determinants of Health & Health Risk Factors & Tasmanian Health Pathways Elvie Hales, Director, Primary Health Systems E: ehales@tasmedicarelocal.com.au, P: 6425 8500ehales@tasmedicarelocal.com.au Maree Gleeson, Manager, SDOH & Health Risk Factors E: mgleeson@tasmedicarelocal.com.au, P: 6425 8500mgleeson@tasmedicarelocal.com.au Paul Shinkfield, Project Leader, Tasmanian Health Pathways E: pshinkfield@tasmedicarelocal.com.au, P: 6213 8200pshinkfield@tasmedicarelocal.com.au Catherine Spiller, Project Manager, Tasmanian Health Pathways E: cspiller@tasmedicarelocal.com.au, P: 6213 8200cspiller@tasmedicarelocal.com.au Care Co-ordination for People with Chronic Disease & Aged Care Clients Mark Broxton, Director, Clinical Services E: mbroxton@tasmedicarelocal.com.au, P: 6341 8700mbroxton@tasmedicarelocal.com.au Lynette Purton, Manager (Operations) Care Coordination E: lpurton@tasmedicarelocal.com.au, P: 6425 8500lpurton@tasmedicarelocal.com.au Jane Barrow, Manager (Projects) Care Coordination E: jbarrow@tasmedicarelocal.com.au, P: 6213 8200jbarrow@tasmedicarelocal.com.au Streamlined Care Pathways Susan Powell, Director, Population Health Programs E: spowell@tasmedicarelocal.com.au, P: 6213 8200spowell@tasmedicarelocal.com.au Rosie Beardsley, Manager, Streamlined Care Pathways E: rbeardsley@tasmedicarelocal.com.au, P: 6213 8200rbeardsley@tasmedicarelocal.com.au Key Contacts