Performance Management Programme

The PHO Performance Management Programme has been designed by primary care representatives, DHBs and the Ministry of Health to improve the health of enrolled populations and reduce inequalities in health outcomes through supporting clinical governance and rewarding quality improvement within PHOs.  Improvements in performance against a range of nationally consistent indicators result in incentive payments to PHOs.

Te Tai Tokerau PHO entered the Performance Management Programme on 1st  January 2006 after meeting the prerequisites for entry.

Performance Indicators and Payment
PHOs are eligible to receive payments as they improve their performance on indicators against targets. For the majority of indicators the closer the PHO moves towards its target the greater the proportion of the payment they receive. Some indicators are provided for information only. Te Tai Tokerau  PHO has been demonstrating consistent progress in the programme to date, and the areas requiring improvement are being addressed with a Continuous Quality Improvement programme in 2008.

There are three categories of indicators:

1. Clinical indicators. These focus on national priority initiatives and therapeutic areas to support best practice, population health initiatives and overcoming barriers to access for specific population groups. The phase 1 indicators for the programme are:

• Children fully vaccinated by their 2nd birthday*
• Influenza vaccinations in the elderly (over 65’s)*
• Cervical smears recorded in the last 3 years*
• Breast screening recorded in the last 2 years*
• Inhaled corticosteroids – average daily doses
• Ratio of metformin to sulphonylurea prescriptions
• Investigation of thyroid dysfunction (TSH vs T4)
• Ratio of ESR to CRP test ordering

2. Process/capacity indicators. These focus on developing PHO’s capacity to operate effective activities to improve performance, and ensuring information is there to support population health and quality interventions. The phase 1 indicators for the programme have been:

• a. Progress against the performance plan
• b. Percentage of valid NHI numbers on PHO Patient Registers
• c. Access for high needs enrolees. At this stage both general practitioner consults and nursing consults will be reported although only the results based on general practitioner consults will be the performance measure until the nursing consult data improves.

3. Financial indicators. The fundamental purpose of these indicators is to measure PHO laboratory and pharmaceutical expenditures against a population based budget adjusted for need. The phase 1 indicators are:

• a. Pharmaceutical expenditure relative to benchmark*
• b. Laboratory expenditure relative to benchmark*

Focus on health disparities
The PHO Performance Management Programme has a strong focus on reducing health disparities. This is achieved through:

• Measuring performance separately for high needs populations where appropriate;
• Weighting payments towards progress against targets for the high needs populations for those indicators relating to an area of health disparity;