Redesigning ACC s Pain Management Services

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1 Redesigning ACC s Pain Management Services Key themes underpinning the redesign Written by: Date: Nic Johnson and Anna Berwick

2 We re redesigning Pain Management Services We re redesigning our Pain Management Services to make sure our clients receive the help they need and their rehabilitation progresses to plan. This document brings together the wealth of information which we re considering as we make decisions regarding what the redesigned service will look like. It includes an overview of what our clients, our staff, our providers and other health professionals have told us. It s not just our information, it s yours too. Feedback closes on 20 May 2015 We re keen to hear from you should you believe there are other areas we should be considering in the redesign of our Pain Management Services. Please drop us a line at [email protected] by 20 May 2015 and let us know what you think.

3 Our aims for the redesigned service It s critical that the redesigned service delivers benefits to our clients, providers, suppliers and staff. We re keen to make a difference for each and every client, ensuring that they receive: better access to the right service, in the right place, at right time improved understanding about what services are available and what to expect from them better experience through streamlined services that fit well with other treatment and rehabilitation services you and our clients are engaged with a more responsive service that meets our clients needs, supporting them to achieve their goals, whatever their situation. We re also redesigning a service that offers our suppliers and providers: better support from ACC throughout the provision of pain services, including a collaborative approach to the continuous improvement to enhance the quality of pain services clear pathways that make it easy for providers/suppliers to access the right services for our clients, at the right time and in the right place a better, more collaborative, experience working with our staff, clients and other service providers to achieve real outcomes for clients streamlined and easy to use Pain Management Services We can t do this alone We are keen to hear from others about what it would take to achieve our objectives for the redesigned Pain Management Service. So, we spoke with our clients, current providers, other health professionals and took an in-depth look into our internal service data. The following pages provide and overview of what these groups told us. 3

4 What our clients say We asked Colmar Brunton to speak to over 1200 clients about their experience of ACC s current pain management services. They said: Assessment and referral processes need to be simpler and smarter. The time between assessing their needs, making a referral and starting a programme need tightening. They also wanted us to accommodate what s important for them. Client communication and understanding needs to be at the forefront of service delivery. Our clients want to be a part of the decision making process, fully understand what services they re being referred to and why. They want recommendations from everyone involved in their rehabilitation to be consistent. Client expectations are critical to the success of the programme and need to be positive and realistic. Our research showed that recommendations provided to clients at the time of referral can influence perceived outcomes of the service. Outcomes need to be realistic and include strategies for self-management beyond the initial pain service. Our clients were more likely to say that a service was worthwhile if they were able to return to their normal lives - even if their pain remained. The opposite was true of those who believed the outcome was to be pain free. Also, a perceived negative outcome from one service reduced the likelihood of a successful outcome in subsequent services. 4

5 What our data tells us In-depth analysis into our internal service data presented some interesting trends and opportunities for consideration, including: Age matters who s using the services? The biggest uses of ACC Pain Management Services are people in the 41-50s age group. Increasing numbers of those aged 51 plus are accessing the services than previous years. Whilst those 19 years and younger make up less than 5% of those accessing the Pain Management Services. Not all current services are used equally. Interventional pain management is the most frequently used service and accounts for just over half of all Pain Management Services used. Followed by Functional Reactivation Programme and Comprehensive Pain Assessment (20% and 12% of PM volumes respectively). Access to services after an injury is inconsistent. A quarter of clients received their first pain service within 3 months of injury with 20% accessing their first service after 2 years. Client ethnicity is varied and the mix year on year is approximately 79% European, 9% Maori, 5% Asian, 2 % Pacific people and 5% other. 5

6 Insight from our providers and other health professionals In February and March 2015 we held seven workshops throughout New Zealand. Our aim was to bring together people with an interest in pain management to discuss the challenges and opportunities for a redesigned service. The workshops Nearly 250 people attended these workshops. They represented providers, professional bodies, special interest groups, tertiary institutions and service users. 6

7 Insight from our providers and other health professionals The challenges A number of reoccurring challenges with the current services were identified by our providers and other health professionals at the Redesigning Pain Management workshops. These include: Timeliness is key and reducing the amount of time between a clients needs being identified, a referral taking place and a subsequent service being delivered with the client, should be a key focus the new service. Communication. A large number of people can be working with a single client however, communication between all parties involved in the care doesn t always work as well as it could. Knowledge and understanding of pain management is varied among ACC staff, providers and health professionals. Screening. There s no clear process for the early identification and management of those at high risk of developing a pain related disability. Access to services, especially in more rural areas can be a challenge, particularly given workforce limitations such as the low number of pain specialists in New Zealand. Current contracts are complex and not well understood by clients, ACC and providers who find it challenging to get the right service for our client. The current services aren t flexible enough for providers to meet client needs and are administratively burdensome. 7

8 Insight from our providers and other health professionals The opportunity for a truly client-centred approach Workshop participants identified that there were a number of opportunities for the redesigned service to adopt a client-centred approach that takes into consideration the client s goals and situation (including family/whānau). Other key opportunities identified as supporting the client centred approach included: A simplified model of service delivery including simplification of the contracts and clear pathways for accessing Pain Management Services. Greater flexibility within services ability to tailor the programme for meeting the needs of our clients, with multidisciplinary and interdisciplinary teams where appropriate. Timely and responsive services with early screening/triage will help identify rehabilitation needs and treatment pathways that support proactive recovery. Improved access (both availability of services and timeliness) to services and support for clients, particularly those in more rural areas. Encourage communication and collaboration between all stakeholders that support client goals and outcomes. Potential role for a Key Worker i.e. a clinician/therapist who takes a lead in coordinating care. Greater focus on education through services that supports the education of clients, providers, health professionals and ACC on best-practice pain management and equips clients with self-management strategies. 8

9 Insight from our providers and other health professionals Other opportunities In addition to the common themes identified, we ve also taken note of a number of other reoccurring opportunities identified by the participants. These include: The critical role of Primary Care in PM Biopsychosocial model Public education on Pain Management Greater autonomy in decision-making Simplified reporting requirements for providers Potential role for other provider groups eg Pharmacist role in medicine reconciliation IT systems that support service delivery Review of funding Importance of health professionals skills and competencies Greater collaboration between Ministry of Health and ACC Outcome-based service delivery Role of peer review for health professionals and peer support for clients Earlier multidisciplinary assessment and recommendations (shorter version of the Comprehensive Pain Assessment) Integrated services Streamlined approval process for access to treatment Potential role for group education sessions for clients How we manage performance in PM Role of Interventional Pain Management (IPM) 9

10 Experiences of ACC staff We asked our claims management staff about their involvement working with clients experiencing injuryrelated pain concerns. The following themes were identified from their experiences: Identification of pain concerns by claims management staff can occur in a number of different ways. These include reading medical notes and listening to what the client says, and also doesn t say. Multiple pain management services can be confusing, making it challenging to identify the most appropriate service for their client. Other rehabilitation services are also being used for the purposes of pain management e.g. Training for Independence Advisory Service. Education on pain and it s management is seen as of benefit to the role of claims management staff in their interactions with their clients. Early screening mechanisms were identified as being of benefit for staff and clients. Easy access to pain management and support service for all clients, particularly those in more rural areas. 10

11 What s next Let us know your feedback We re including this wealth of information in our in initial design concept for the redesign Pain Management Service. Should you believe there are other areas we should also be considering please drop us a line at [email protected] Presenting the initial design concept We ll be seeking your thoughts on the initial design concept before progressing into the detailed design. We ll be in touch in the coming weeks with more information on how you can be involved. Thank you to all our clients, current providers, ACC staff and other health professionals who took the time to assist in this crucial stage in the redesign of Pain Management Services. 11