Future Directions of SA Health within the Casemix Context

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Future Directions of SA Health within the Casemix
Context
Dr Tony Sherbon Chief Executive, SA Health

• 2008 Casemix Conference
• Adelaide, South Australia

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Presentation format

• Context
• Why do we need reform
• Brief overview on the national health reform
  agenda
• Detailed overview of the reforms planned and
  underway in SA
• How casemix can support these reforms

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Context

• Demographics
• SAs population is around 1.6M, with approx
  28,000 Indigenous people
• SA has the oldest population in Australia (15.2
  are over 65 in SA compared to 13.2 nationally)
• SA has the lowest birth rate in Australia (11.6
  per 1,000 population compared to 12.8 nationally)
• 74 of all people in SA live in metropolitan
  Adelaide
• 16 of the states land mass is classified as
  remote and 74 as very remote

Data sources ABS Australian Historical
Population Statistics, ABS ERP, ABS Census
Geography Data
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Context

• Health Status
• 83 of SA people surveyed rate their own health
  as good, very good or excellent
• SA life expectancy is 78.6 years for males 83.6
  females (both within 0.1 of national average)
• SA has the lowest infant mortality rate in
  Australia at 4.0 deaths/1,000 live births (4.8
  nationally)

Data sources South Australian Monitoring
Surveillance System, ABS Australian Historical
Population Statistics, ABS Deaths
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Context

• Risk factors profile in SA
• 21 of people 15 are current smokers
• 57 of people are classified as overweight or
  obese
• 28 of people 16 are at risk of harm from
  alcohol
• 47 of people are not doing enough physical
  activity
• 90 of people 19 are not eating 5 serves of
  vegetables per day

Data source South Australian Monitoring
Surveillance System
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Context

• Prevalence rates for chronic diseases in SA
• 7.2 of people have Diabetes
• 12.9 of people have Asthma
• 7.8 of people have Cardiovascular disease
• 4.1 of people have Osteoporosis
• 20.4 of people have Arthritis
• 11.9 of people have Mental Health condition

Data source South Australian Monitoring
Surveillance System for people 16 years and over
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Why we need reform

• Patient Activity Levels
• Total public hospital separations in 2007-08 were
  368,328 11.4 growth since 2003-04
• Total public hospital ED presentations in 2007-08
  were 362,901 17.2 growth since 2003-04
• 3.1 public hospital beds per 1,000 population
  (highest in the nation)
• In 2006-07 had
• RSI of 1.06
• DOSA of 80
• Only 64 of ED patients seen on time
• 1,441 people on elective surgery waiting lists,
  with 850 of them waiting more than 12 months

Data sources ISAAC, EDDC, BLIS, Australian
Hospital Statistics
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Why we need reform

• Changing demographics
• Ageing population
• Prevalence of chronic disease
• Increasing demand
• Community expectations
• Technological improvements
• Workforce shortages
• Ageing of the workforce
• Decreasing numbers entering the workforce
• Increasing cost

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Why we need reform - Population Changing profile
Data source Planning SA High Series (July 2007)
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Why we need reform Projected admissions
Data source AIMS (Hardes) Model
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Why we needed reform Projected labour demand
and supply

Data source John Spoehr (2004) Sleepers Awake
demographic change, ageing and the workforce.
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Why we needed reform Chronic disease hospital
admissions
Data source ISAAC, AIMS Model
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National Reform Initiatives

• Elective Surgery Reduction Plan
• 5bn public hospital infrastructure funding
• COAG considering reforms funding
• Complex chronic disease management
• Hospital and health workforce reform (including
  activity based funding)
• Prevention
• Cancer
• Indigenous health
• e-Health

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National Reform Initiatives Accountability Focus

• COAG OOMS performance indicators and outcome
  measures
• Funding tied to performance against indicators
• Greater accountability and transparency through
  public reporting
• More opportunities for comparability between
  jurisdictions
• All leading to much more emphasis on data,
  measurement and casemix

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South Australias Health Reform

• South Australias Strategic Plan
• 98 targets for the next decade
• Targets for improving wellbeing across
  preventative health and life expectancy
• South Australias Health Care Act
• Legislative changes to governance arrangements
• New external accountability body - HPC
• South Australias Health Care Plan
• Significant capital investment
• Better coordination of hospital services
• Strengthening out of hospital sector

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SA Health Care Plan 2007-2016

• Right care, Right time, Right place
• Increased focus on primary health care, health
  promotion and disease prevention
• Better coordinated hospital services
• Improved management of disease
• Sets the framework for
• Service redistribution
• Demand management
• Clinical engagement
• Workforce development
• Infrastructure investment

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SA Health Care Plan 2007-2016

• Outlines most significant investment in health
  care in South Australias history
• new state-of-the-art hospital facility
• investment in other major hospitals
• better coordinated hospital services
• GP Plus Health Care Services
• improved information technology
• a responsive health workforce for the future

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System Architecture
Clinical Networks Statewide Plans
GP, Private, NGO, Commonwealth and Community
Sector
Community individual capacity for own health
and wellbeing
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Service Re-distribution

• Health Care Plan
• The new MJMH (central), FMC (south) and LMHS
  (north) will form the backbone of the states
  high level critical and complex hospital
  services.
• Three general hospitals in metropolitan Adelaide,
  TQEH, Modbury Hospital and Noarlunga Hospital
  providing services to their local communities.
• Separate Country Health Care Plan has been
  developed, reviewed and is currently under
  consideration by the Minister for Health.

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Demand Management

• GP Plus Health Networks and GP Plus Health Care
  Centres
• Integrated services and continuing care beyond
  hospitals contributing to a reduction in the
  number of hospital admissions and rate of
  unplanned readmissions
• Health Improvement Plans
• Developed for geographical populations within
  Network regions
• Population health approach, dealing with issues
  of equity in health status and access to health
  services
• Other Statewide Plans
• Specific plans dealing with chronic disease,
  older people, prevention, palliative care,
  stroke, child health, womens health and mens
  health

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Clinical Engagement

• Clinical Senate
• Eight Statewide Clinical Networks
• Future Directions Committee
• Purpose
• Increased clinician involvement in service
  planning
• Better coordination of services
• More engagement leading to higher staff
  satisfaction and higher staff retention rates

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Workforce Development

• Workforce innovation - New roles
• Lifestyle advisors
• Nurse sedationists
• Physician assistants
• Workforce Strategy Committee
• Increased local training
• Sustained immigration

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Impact of the SA Health Care Plan on Projected
Admissions
Data source AIMS (Hardes) Model
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Casemix Context in SA

• Casemix funding implemented in SA in 1994-95
  remains the primary funding tool for hospitals
• Population based funding model is run in parallel
  to casemix but only to inform budget setting
  process
• SNAP data are captured for non-acute and
  sub-acute services but not currently used for
  funding
• Casemix is used extensively for performance
  monitoring and benchmarking
• Classification and costing of patient services is
  applied in demand analysis and service planning
• Concept of weighted patient activity to describe
  patient workload and resource consumption is
  accepted by other government agencies (in
  particular DTF and AGs)

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Casemix underpinning reform

• gt Casemix data used for
• Role delineation and service planning
• Demand analysis
• Benefit analysis of different models of care
• Supporting the Health Performance Council in its
  monitoring role
• Undertaken first step in classifying patient
  encounters within the Out of Hospital sector
  through development of a OOH Minimum Data Set

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Challenges for Casemix

• Standard terminologies and classifications beyond
  the acute inpatient setting (including uptake of
  SNOMED CT)
• Consistency in the way we describe conditions and
  procedures in the hospital sector and out of
  hospital sector, and how patient encounters are
  costed, so we can
• Gauge the efficacy of treatment (with assistance
  of data linkage)
• Gauge the quality of treatment (re-admits and
  re-presentations)
• Measure the extent of substitutable services
  between the sectors and the financial impact of
  alternative models of care
• Casemix funding should be linked to outcomes
  where possible
• Clinical outcomes
• Safety and quality
• Classify services consistently across both
  sectors and fund based on patient conditions and
  outcomes, not place of treatment

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