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"Pathology - A Problem in Search of a Solution?"

Informa 4th Annual Pathology Forum at Sydney Harbour Marriott Hotel - 14 October 2013
by

Ken Barr

on 13 January 2017

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Transcript of "Pathology - A Problem in Search of a Solution?"

4th Annual National Pathology Forum
14 – 15 October 2013


PATHOLOGY – A PROBLEM IN SEARCH OF A SOLUTION
Ken Barr
Group Executive Director
"licence to print money"

Getting society and politicians to understand the value Pathology brings to protecting health and potential contribution to efficient delivery of clinical pathways leading to better outcomes : VALUE > COST

Lack of public awareness of what Pathology is?
‘Without integration at various levels [of health systems], all aspects of health care performance can suffer. Patients get lost, needed services fail to be delivered, or are delayed, quality and patient satisfaction decline, and the potential for cost-effectiveness diminishes.’


New Royal Adelaide Hospital

Have a regulatory framework that encourages integration and integrated care
Have a financial framework that encourages integrated care
Provide support to innovative approaches to commissioning integrated services
Apply national outcome measures that encourage integrated service provision
Invest in continuous quality improvement including publishing the use of outcome data for peer/public review



Key issues in creating an enabling policy environment for integrated care

Supporting health and social care teams providing co-ordinated care to frail older people in their homes/community
‘Virtual wards’ providing home-based case management to high-risk individuals and led by health care teams with POCT support
Disease management programs focusing on people with specific conditions such as diabetes, heart failure or COPD
Managed networks that are not solely acute focused to strengthen co-ordination of care for people with specific health/social care needs
Push Commissioning/Accountable Care Organisations - funding pathways and create incentives to share risk and promote innovative ways of preventing a hospital focused system e.g. Kaiser Permanente

Pathology Network: Adding Value

Barriers to Change


Addressing an unsustainable acute sector
Developing capacity in primary care to take on new services
Managing demand and developing new care models
Establishing effective clinical leadership for change
Overcoming professional tribalism and turf wars
Addressing the lack of good data and IT to drive integration
Creating a narrative about new models of care
Establishing new forms of organisation/governance
Learning from elsewhere - overseas

-
between health services, social services and other care providers (horizontal integration)
- across primary, community, hospital and tertiary care services (vertical integration)
- within one sector (within mental health services, multi-professional teams or networks)
- between preventive and curative services
- between providers and patients to support shared decision-making and self-management
- between public health, population-based and patient-centred approaches to health care

Key Forms of Integrated Care


Align financial incentives
Support providers to work collaboratively - avoid perverse effects of activity-based payment
Promote joint responsibility for the prudent management of financial resources
Encourage the management of ill-health in primary care settings that help prevent admissions and length of stay in hospitals/nursing homes

Money!

“The patient’s perspective is at the heart of any discussion about integrated care. Achieving integrated care requires those involved with planning and providing services to IMPOSE THE PATIENT’S PERSPECTIVE OF SERVICE DELIVERY”
(Shaw et al 2011, after Lloyd and Wait 2005)

Integrated Care

Providing reliable laboratory measures
Establishing a standardized laboratory database for outcomes research and health care improvement
Participating in design of standardized practice algorithms e.g. test ordering, interpretation, and therapeutic choices
Developing patient health information tools to improve patient care
Extending laboratory reporting to include improvements in how information is presented
Using information system tools to improve reliability of quality e.g. in hospital, long-term care facilities, and at home
Providing clinical consultations when appropriate.

Schuerch et al., 2008

The Role of the Pathologist in improving laboratory clinical effectiveness
Life Expectancy (2011)

GDP % Health Expenditure (2011)

Hospital Beds per 1,000 popn. (2011)

Average Length of Stay (2011)

Public Expenditure per Capita (2011)

(Ham and Smith, 2010; Goodwin 2011)
Welcome to Australia?!
Pathology - Upstream or Downstream?
Complex mix of disciplines
Problem - what problem?
Lack of comprehension of 24/7 issues
Impact on clinical pathways and outcomes not understood?
Mainly indirect link to patients
Seen as aloof?
Rise in demand and cost
Pathology not a problem just complex and misunderstood?
"back office function"
"commodity for trading"
"optional extra"
"silo business"
"For our patients and our population"
"One less Socialist to worry about George"!!!
Hear! Hear! Hear!
Healthy
Sick
(Kodner and Spreeuwenbur, 2002)
Closer Care

Self Care
Primary Care
Hospital Care
Palliative Care
Patient Self-Management
Patient Held Records
Easy Access to Staff
Easier Communication

Diabetes
Obesity
Heart Disease
Cancer
Hypertension
COPD
63%
4.2%
200 new registered cases every day
4.7%
1.5% = $3.8bn
21.5%
7.5% >40YR
(Goodwin et al 2011; Rosen et al 2011)
RAH
Value = quality - cost
What is the Real Problem?

Second leading cause of avoidable hospital admissions
"There's no more money stupid!"
Public
Private
Trouble is we all love hospitals!
Full transcript