Value based healthcare highlights and achievements for 2022

December 2022 edition

Value based healthcare is an important overarching approach to support NSW Health to achieve the vision outlined in Future Health.

In 2021-22 we focused on improving alignment across the statewide programs and progressing work on the enablers that underpin value based healthcare.

This article spotlights some of the key achievements across our value based healthcare programs and initiatives at a statewide level. We would also like to acknowledge the significant contributions of locally-led value based healthcare initiatives, some of which were highlighted at value based healthcare week in May.

Highlights from the statewide programs

Collaborative Commissioning

Collaborative Commissioning is a one-system approach that aims to incentivise locally developed integration of care across the entire continuum. It also seeks to embed local accountability for delivering value-driven, outcome focused and patient centred health care, whilst reducing cost and pressure on community and hospital services.

There has been great progress across the six Collaborative Commissioning partnerships this year, including:

• Western Sydney Care Collective are implementing their Value Based Urgent Care Service and Cardiology in Community care pathways. They have launched four urgent care services and have seen over 2,486 patients.
• Northern Sydney are implementing urgent care services for frail and older people, including supporting General Practitioners to actively manage frail and elderly patients in the community. More information is included in the Commonwealth Funding for Northern Sydney Collaborative Commissioning partnership article.
• Western NSW / Far West are implementing the “Living Better and Stronger” care pathway that provides patient-centred care to those who have poorly managed type 2 diabetes.
• Murrumbidgee are implementing the “Living Well, Your Way” model of care focused on people diagnosed with Congestive Heart Failure and/or Chronic Obstructive Pulmonary Disease. More information is included in the Living Well, Your Way article.
• South East NSW are in the Joint Development Phase and are focusing on a Chronic Obstructive Pulmonary Disease care pathway.
• Nepean Blue Mountains are also in the Joint Development Phase and are using Lumos insights to focus on an active clinical handover of chronic conditions.

Commissioning for Better Value

Commissioning for Better Value (CBV) is an outcomes based approach to design, implement and manage services that support patient care with a focus on outcomes and experiences. Following the release of the CBV Strategy 2021-24, we published the Implementation Plan and Monitoring and Evaluation Plan this year to support achievement of the CBV strategic objectives.

We continue to raise awareness and support local implementation of CBV by:

• sharing case studies on how CBV is delivering benefits in areas such as medical imaging, orthopaedic hips and knees prostheses, and oncology
• developing a CBV community of interest for sharing information and resources
• gathering feedback from stakeholders who have used CBV and reviewing capability needs to support work next year on building capability and partnerships.

A review of the first year of the CBV strategy will also be published on the CBV sharepoint site shortly.

Integrated Care

Integrated Care involves the provision of seamless, effective, and efficient care that reflects the whole of a person's health needs:

• from prevention through to end of life,
• across both physical, psychosocial, and mental health and;
• in partnership with the individual, carers, and family members.

This year, the Integrated Care Implementation team have been working closely with districts and networks to lead partnerships and deliver seamless care. This has included launching the ED to Community (EDC) initiative which provides community-focused coordinated care and case management support for frequent attenders of ED.

The team have partnered with the George Institute and district and network end-users to review and refine the Risk of Hospitalisation (RoH) algorithm to identify people suitable for the existing Planned Care for Better Health initiative. This initiative aims to reduce unplanned hospitalisation and improve patients experience and outcomes by working in partnership to coordinate their care.

The team have also established Communities of Practice to facilitate knowledge sharing, better collaboration and improved partnerships. In addition, three learning modules introducing the principles and benefits of integrating care are due to go live before the end of 2022. They will be accessible to all healthcare providers across NSW.

Leading Better Value Care

This year, the team have focussed on growing the impact and sustainably embedding Leading Better Value Care programs, through work such as:

• Increasing the consumer and carer voice, including through a Carer’s Experience Survey for Renal Supportive care, and three chronic wound consumer videos which share the patient perspectives of wound care.
• Supporting best practice implementation through communities of practice and publishing clinical priorities and organisation models briefs for high risk foot, inpatient diabetes, and osteoporotic refracture prevention, and the orthogeriatric clinical practice guide.
• Increasing access to care for those living in regional and remote areas, by including the High Risk Foot Service and Osteoporotic Refracture Prevention in the Isolated Patient Travel and Accommodation Scheme.
• Using evidence to inform future resourcing and service planning through economic appraisals for four clinical cohorts including chronic wound management, renal supportive care, direct access colonoscopy and hyperfractionated radiotherapy for early stage breast cancer, publication of the osteoporotic refracture prevention longitudinal study, and continued development of the Registry of Outcomes, Value and Experience (ROVE) Analytics Application which gives NSW Health staff direct access to service and system level linked data, including patient experience, outcomes and clinical and benchmarked data for selected clinical cohorts to monitor the impact of initiatives.
• Building capability through the Thinksulin decision support App (a NSW Health awards finalist) and the pilot of a NSW Health Wound Care Formulary to support improved selection and use of products for the management of chronic wounds, with the aim of improving wound healing as well as patient and clinician experience and improved efficiency and effectiveness
• Improving the cultural appropriateness of services through the Healthy Deadly Feet initiative to increase access to Aboriginal workforce for Aboriginal people with or at-risk of a diabetes-related foot complications, and training in cultural responsiveness.

Highlights from value based healthcare initiatives and events

Virtual Care

Virtual care is a key enabler of value based healthcare. The NSW Virtual Care Strategy was launched by the Secretary in February, providing a roadmap to transform our health system by integrating virtual care as a safe, effective and accessible option for healthcare delivery in NSW. This year the team have focussed on local engagement with districts and networks to support implementation of the Strategy. Supporting the strategy is a Monitoring and Evaluation Plan which aims to assess virtual care across the four dimensions of value based healthcare inclusive of patient, carer and clinician experience. Early monitoring includes an early impact analysis of utilisation, assessment of patient and clinical experience and an upfront economic appraisal.

As part of the monitoring and evaluation approach:

• the Bureau of Health Information (BHI)was commissioned to develop and undertake assessment of patient experience of virtual care. The BHI recently shared insights from the second survey of NSW public hospital outpatients using virtual care. Feedback showed:
1. Around nine in 10 patients (91%) rated their virtual care throughout 2021 as ‘very good’ or ‘good’. More than 9 in 10 (95%) said the virtual care they received helped them.
2. The more virtual care appointments a patient had, the more positive they were likely to be about their overall experiences. Find out more on the BHI website.
• the clinician experience survey was developed to gather evidence across the domains of quality of care, clinician engagement, interprofessional collaboration and psychological safety. This instrument has been used to assess the clinician experience of providing virtual care and to inform future virtual care approaches.  It is now being adapted to measure clinician experience for many other cohorts and was recently published in the BMC Health Services Research journal.  

Value based healthcare week

Value based healthcare week 2022 was held in May. More than 580 people from across NSW Health joined at least one of 10 dedicated sessions on how to embed value based healthcare. 

Survey feedback from the event was positive, with attendees commenting on the diversity of the program and high-quality presentations. We will be building upon this in 2023 with the VBHC event series.