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Reconnecting unenrolled patients with primary care for better health outcomes


Did you know that an estimated 11 per cent of patients presenting for care at Waikato Hospital's emergency department (ED), do not have a nominated GP?

Pinnacle MHN have supportive, expert general practice teams. We know primary care can partner with patients and their whānau to proactively manage most of their health needs, resulting in better outcomes.

What is our plan?
Pinnacle MHN and Waikato Hospital's emergency department (ED) will be working together to identify and support unenrolled patients.The aim is to engage or re-engage patients who are not currently enrolled in a PHO with general practice, to give the patient and their whānau more control in managing their health and ultimately reduce unnecessary ED attendances.

Waikato Child Health Coordination Services can also refer unenrolled mothers of babies aged six weeks to three months to a general practice of choice.

How will it work?
Until 30 May 2018 all unenrolled patients who present at ED, and who meet the criteria*, will be referred to their chosen practice to enrol and receive a free extended consultation with a practice nurse or GP (this is funded, so no co-payment is applied).

ED staff will provide a list of participating practices to patients to select one that meets their needs. ED will then fax details (by NHI) of a patient's nominated general practice to Pinnacle MHN's Clinical Coordination Centre to coordinate all referrals.

What does this mean for your practice?
When a patient selects your practice, your team can access specific funding to re-engage with the patient. You can help them enrol, tell them about your great services, and help them choose the health services that are right for their individual needs. The patient may consent to receiving a health intervention offered at this consultation (examples of this could be immunisations, smear, LTC review, CVRA).

Reimbursement criteria and value
The practice will receive:

  • $70 excl GST, for an individual patient (30-60 minute consultation)
  • $100 excl GST for whānau enrolment: family/whānau members who attend the consultation with the non-enrolled patient and are not enrolled with any PHO will be invited to enrol as well (30-60 minute consultation).

Claiming method

  • Medtech practices will complete an advanced form.
  • Non-Medtech practices will complete a manual claim form.

*Criteria for ED patients to enrol

  • Waikato domiciled people who areeligible for publically funded health services in New Zealand and who attend Waikato Hospital ED and are not currently enrolled with a Waikato PHO.
  • Unenrolled mothers of babies aged six weeks to three months.

Waikato ED will determine eligibility through the use of an NHI lookup tool.

Exclusions

  • Patients domiciled in other DHB districts.
  • Patients who attend emergency departments in rural hospitals.
  • Patients/family/whānau members who are currently enrolled in a Waikato PHO.
  • International visitors.
  • People not eligible for publically funded health services in New Zealand.

Provider inclusion/opt out process
All Pinnacle MHN practices who are currently accepting new enrolments will be included as providers of this service (and therefore on the list of practices provided to ED) unless they choose to opt out.

If you are accepting new enrolments, you will have a contract sent to you. Please sign and return this to your practice support ASAP.

If you wish to opt out, or you have queries please contact your practice support ASAP.

For any further inquiries, contact network lead - clinical services Puamiria Maaka: puamiria.maaka@pinnacle.health.nz or 021 545 3084.

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