Preventive healthcare in one health ecosystem – Pen CS and Western Sydney Partnership lead the way
- Written by Helen Huynh
Committed to building a healthier Australia and providing person-centred, value-based care through data-driven improvement in general practice, Pen CS, WentWest, the Western Sydney Primary Health Network and Western Sydney Local Health District (LHD) are collaborating to build one health system. The approach underway - progressive and a first in Australia – was highlighted in the first session of the Talking HealthTech Autumn Summit 2021.
“Australia is experiencing a syndemic in chronic disease as a result of the COVID-19 pandemic,” said Edweana Wenkart, Chief Executive, Pen CS. “Poor management of chronic disease costs more than $320 million a year[1] and COVID-19 has caused people to stay away from the healthcare system during the last year, which may result in serious illness.[2]
The Western Sydney partnerships addresses health prevention and better chronic disease management through a one health system approach. This health system, supported by the use of data, delivers transparency and accountability to deliver truly value-based care.
“In Western Sydney, we apply a ‘one health system’ approach where WentWest supports primary care, the Western Sydney LHD delivers acute services and both of us are covering various aspects of community health. This approach, underpinned by technology developed with Pen CS, is critical to changing the way services operate and deliver outcomes for the population,” said Ray Messom, Chief Executive, WentWest.
“The long-standing partnership between Western Sydney Local Health District and WentWest is at the centre of our ambition to deliver one healthcare system”, said Richard Alcock AO, Chairman, WSLHD.
In Western Sydney, providers and professional groups work together in multidisciplinary teams to provide patient centred, value-based models of care for patients. Dr Kean-Seng Lim stated that data and integrated team care is the foundation for creating one health system across the patient journey.
“Integrated care which focuses on the coordination of care and continuity of care is at the heart of one health system[3]. This approach along with quality data provides general practices and Aboriginal medical services with the ability to evaluate the cohort and individualise care according to the patients’ needs. This is key to improving patient experience and outcomes,” said Dr Kean-Seng Lim, General Practitioner, CareMonitor Co-Founder and AMA (NSW) Immediate Past President.
“Pen CS has a long history of working with general practices and WentWest on projects which link data between primary and acute care. This success enables us to extend collaboration with Western Sydney LHD and patients to produce the next generation of integration”, said Edweana Wenkart.
“Western Sydney Diabetes Joint GP Specialist case conferencing is a great example of our one system approach. From Western Sydney’s integrated datasets of over 720,000 patient records in any given month from more than 230 practices, four public hospitals and six community health centres , our partnership has achieved positive outcomes for patients in diabetes prevention and management, reducing the impost on hospitals,” said Ray Messom.
Western Sydney Diabetes annual review[4] reports a significant mean reduction for enrolled patients in HbA1C by -0.71% (95% CI). A 1% drop in HbA1C is associated with 21% reduced risk of death, 14% reduced myocardial infarcts, 37% less microvascular complications and 43% amputations. This is a strong signal affirming the effectiveness of this program.
For more information about the panel session, visit www.pencs.com.au/pen-cs-at-talking-healthtech-autumn-summit-2021/.
The panel discussion is titled ‘Preventative Healthcare to Reduce Avoidable Hospitalisation and Readmission’ and will focus on how PHNs, LHDs and healthcare providers are using data and technology to drive integrated team care and break down silos in healthcare. The panel session will feature moderator Edweana Wenkart, CEO, Pen CS and panel members Ray Messom, CEO, WentWest, Richard Alcock AO, Chairman, Western Sydney Local Health District, Dr Kean-Seng Lim, GP and CareMonitor Co-Founder.
Potentially preventable hospitalisations in Australia Statistics:
- One in two Australians suffer from chronic disease, which is responsible for 83 per cent of all premature deaths in Australia, and accounts for 66 per cent of the burden of disease.[5]
- AIHW study which states that in Australia in 2018, 89 per cent of deaths were associated with 10 chronic diseases.[6]
- 47% of Australians suffer chronic disease and 51% of hospitalisations in 2018 involved select chronic disease.[7]
- Poor management of chronic disease costs more than $320 million a year[8].
- Around 7% of all hospitalisations were classified as potentially preventable.[9]
- There were nearly 748,000 potentially preventable hospitalisations in Australia in 2017–18.[10]
- Nearly 10% of all hospital bed days were for potentially preventable hospitalisations.[11]
WentWest Statistics from 2019-2020 Annual Review[12]:
- Western Sydney population 1 million +
- 249 accredited practices to RACGP standards
- 347 number of general practices in Western Sydney
- 52 new health pathways localised and published
- 316,370 total patient records linked
- $24.3 million spent on mental health services
- 5,630 clients referred into primary mental healthcare services
- $32 million spent on commissioned services and grants
References:
[1] https://grattan.edu.au/poor-management-of-chronic-disease-costs-more-than-320-million-a-year/
2 https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/chronic-disease/overview
5 https://apo.org.au/node/94416
6 https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/chronic-disease/overview
7 https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/chronic-disease/overview
8 https://grattan.edu.au/poor-management-of-chronic-disease-costs-more-than-320-million-a-year/
12 https://wentwest.com.au/news-and-resources/annual-review/
About the Speakers
Edweana, CEO, Pen CS
Edweana is the Chief Executive of Pen CS, Australia’s market leader in providing patient to population health informatics in primary care. Pen CS works with 28 of 31 Primary Health Networks and more than 6,000 general practices and aboriginal medical services. Pen CS technology solutions are used to drive data-driven quality improvement that support healthcare providers and deliver better patient outcomes. Edweana is a member of the Australian Institute of Digital Health and Medical Software Industry Association. She holds an MBA from AGSM and Bachelor of Arts from University of Sydney. Prior to her role at Pen CS, she founded and managed an award-winning public relations and marketing agency Tsuki for 13 years after a successful career in feature film production working on movies including The Matrix and Australia. Edweana is a Board Member of both Ocean Health Systems and CareMonitor.
Richard Alcock AO, Chairman, Western Sydney Local Health District
Richard Alcock joined the Board of WSLHD in August 2016 after five years as deputy chairman and chairman of the Finance and Performance Committee of the Sydney Children’s Hospitals Network (SCHN). Prior to his appointment to the SCHN board, he was a director of the Sydney Children’s Hospitals Foundation.
In 2017 he was appointed Vice Chairman of Bank of America in Australia. He was previously the Managing Director and Co-Head of Transport, Infrastructure, Power & Utilities at Merrill Lynch Markets (Australia) Pty Limited from 2007. Formerly a corporate lawyer for 25 years with Allens Arthur Robinson he worked in Sydney, Singapore and Jakarta, was made a senior partner, head of Governance, and chairman of the Ethics Committee. Richard is a director of the UNSW Foundation Limited, and Art Exhibitions Australia Limited, a not-for-profit company limited by guarantee, established to bring major art exhibitions to Australia in partnership with State galleries and museums. In 2017, Richard was awarded the Officer (AO) in the General Division, for distinguished service to the community, particularly through health management roles, and to the law, corporate governance, and higher education organisations.
Ray Messom, CEO, WentWest Limited (Western Sydney Primary Health Network)
Ray is the CEO of WentWest, which leads primary health care system integration in Western Sydney. As the Primary Health Network, WentWest continually reimagine how primary, community, acute and social care is delivered, commissioning services into targeted areas of need and supporting primary care transformation and integration. WentWest aims to remove organisational and professional barriers, alleviate the siloed fragmented nature of care and pursue ‘one Western Sydney health system’ in order to provide value-based and person-centred care.
Prior to joining WentWest, Ray led System Information and Analytics (SIA) Branch for the NSW Ministry of Health, which supports the data and analytical needs of the $22 billion NSW public health system. It leads data governance system-wide, research on, and evaluation of incentives, key performance indicators and health care improvement initiatives. Ray has also work with PricewaterhouseCoopers (PwC) Canada and PwC Australia where he advised government, private, NGOs and academic sectors across Australia and Canada on several transformational reform agendas. As a health economist and senior administrator for more than 20 years, Ray has dedicated his career to the translation of evidence into policy and policy into outcomes for citizens.
Dr Kean-Seng Lim, CareMonitor Co-Founder, AMA (NSW) Immediate Past President and GP
Dr Lim is a General Practitioner and GP Principal in a small group practice in Mt Druitt, the Immediate Past President of AMA (NSW), and Co-Founder of CareMonitor, a Digital Shared Care and Patient Provider Partnership Platform. He is a past Board member of Western Sydney PHN and current Clinical Council member. In 2015 he was awarded the RACGP General Practitioner of the Year award. He has previously served on the RACGP Faculty Board and WentWest Board. Among other things, he has been a Clinical Lead with the National E-Health Transition Authority is one of the developers of the schools based obesity prevention and lifestyle education program - SALSA. He currently serves on several advisory groups including the PIP-QI Data Governance Group, as Co-Lead of NSW Health Primary Care Communities of Practice, and Co-Chair of the Western Sydney Urgent Care Services Development Subcommittee. He has been heavily engaged in the Western Sydney PCMH implementation project, and as a member of the WentWest Clinical leaders group. He is a consultant and trainer with the Health Care Homes Training team, and has delivered educational events for PHN’s across the country on eHealth and PCMH implementation.
About Pen CS
Pen CS, founded in 1993, is the market leader in patient to population health analytics software in primary care. An Australian-owned company, Pen CS’ vision is to build a healthy Australia by supporting data-driven, outcome-oriented, patient-centred care. Pen CS eco system includes more than 6,100 General Practices with over 22 million patient records per month.
Digital health innovation is embedded in our platform and partnerships as a key way of caring for patients and helping those who care for them. This is evidenced by the variety of applications available for General Practices from team-based care planning, to billing efficiency, accreditation, education and condition-specific QI apps e.g. Cancer Screening.
Pen CS has a long history of collaborating with research organisations and government to identify and address rising risks to help reduce healthcare costs, improve patient outcomes and increase provider satisfaction at local, state and national levels.
About WentWest Limited (Western Sydney Primary Health Network)
Primary Health Networks (PHNs) are a federal government health initiative, established with the key objectives of increasing the efficiency and effectiveness of medical services for patients, particularly those at risk of poor health outcomes and improving coordination of care to ensure patients receive the right care in the right place, at the right time. In its role as the Western Sydney Primary Health Network, WentWest focuses on addressing national and regional health priorities in consultation and partnership with local GPs, Allied Health Professionals, consumers and community bodies and the broader health sector.
About Western Sydney Local Health District
Western Sydney LHD is responsible for public health in an acute and community setting for 1 million people in Western Sydney through 14,000 highly skilled and committed people funded by a $1.9 billion budget from NSW Health.
About CareMonitor
CareMonitor is a Sydney based HealthTech startup, transforming healthcare service delivery and patient experience through our innovative digital health management platform.
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