New Zealand's Canterbury District Health Board shares successes in accountable care systems

The King's Fund evaluated transformation efforts by the health system in Canterbury, New Zealand, which is now supporting more people in their homes and communities and has moderated demand for hospital care, particularly among older people. The report details how change was achieved through developing new delivery models, which involve better integration of care across organizational and service boundaries, increased investment in community-based services, and strengthening primary care. Canterbury District Health Board's efforts to transform the health system revolved around three key approaches:

1. The development of a clear, unifying vision of 'one system, one budget.'
2. Sustained investment in giving staff skills to support them to innovate and giving them permission to do so.
3. Developing new models of integrated working and new forms of contracting to support this.

Models implemented in Canterbury include:

• HealthPathways - primary care management and referral pathways developed in partnership between GPs and hospital doctors'
• The acute demand management system - people with acute health needs receive urgent care in their homes or communities from GPs supported by rapid-response community nursing, community observation beds, hospital-based specialist advice and rapid diagnostic tests; and
• The electronic shared care record view - a secure online summary care record, combining an individual's GP records, hospital records, community pharmacy records and laboratory and imaging results. Clinicians across hospital, community and primary care services can view the record, improving information sharing between different parts of the system.