title: Chronic Care Management evolves towards Integrated Care in Counties Manukau, New Zealand.
abstract: Despite anecdotes of many chronic care management and integrated care projects around New Zealand, there is no formal process to collect and share relevant learning within (but especially between) District Health Boards (DHBs). We wish to share our experiences and hope to stimulate a productive exchange of ongoing learning. We define chronic care management and integrated care, then summarise current theory and evidence. We describe national policy development (relevant to integrated care, since 2000) including the New Zealand Health Strategy, the NZ Primary Care Strategy, the development of Primary Health Organisations (PHOs), capitation payments, Care Plus, and Services to Improve Access funding. We then describe chronic care management in Counties Manukau, which evolved both prior to and during the international refinement of theory and evidence and the national policy development and implementation. We reflect on local progress to date and opportunities for (and barriers to) future improvements, aided by comparative reflections on the United Kingdom (UK). Our most important messages are addressed as follows: To policymakers and funders--a fragile culture change towards teamwork in the health system is taking place in New Zealand; this change needs to be specifically and actively supported. To PHOs--general practices need help to align their internal (within-practice) financial signals with the new world of capitation and integrated care. To primary and secondary care doctors, nurses, and other carers - systematic chronic care management and integrated care can improve patient quality of life; and if healthcare structures and systems are properly managed to support integration, then healthcare provider professional and personal satisfaction will improve.
authors: Department of Medicine, University of Auckland, Auckland.
authors: Harry
authors: H
authors: Rea
authors: Tim
authors: T
authors: Kenealy
authors: John
authors: J
authors: Wellingham
authors: Allan
authors: A
authors: Moffitt
authors: Gary
authors: G
authors: Sinclair
authors: Sue
authors: S
authors: McAuley
authors: Meg
authors: M
authors: Goodman
authors: Kim
authors: K
authors: Arcus
mesh_terms: D002908:Chronic Disease; D003431:Cross-Cultural Comparison; D019033:Delivery of Health Care, Integrated / Q000639:trends*; D019468:Disease Management; D019317:Evidence-Based Medicine / Q000458:organization & administration; D006291:Health Policy; D006801:Humans; D017146:Models, Organizational; D009313:National Health Programs / Q000458:organization & administration; D009520:New Zealand; D011320:Primary Health Care / Q000458:organization & administration; D012040:Regional Health Planning / Q000379:methods*; D006113:United Kingdom