Behind the Scenes

Terminology and data structures

There is a complex data model behind all of this; it allows us to describe what is available and to whom, under what packages of care and with what budget, how much will it be subsidised, who delivers the services, are they available directly or just as a coordinated package of care etc.

The data model is very hierarchical and linked; within it specific terminology is used. Here is a little bit of information on the various terminology and structures that exist within TeamCare:

Programme

A Programme is typically the clinic area that the services relate to, for example Primary Mental Health, Diabetes Care Services, Mobility Services etc.

Services

Once enrolled into a Programme, the patient would be allocated some relevant services, for example Counselling, Dietary Service, Physiotherapy.

Sessions

Each service comprises of a number of sessions eg for Counselling, there may be 5 sessions available. They could all be counselling sessions but one could be an initial triage session and the funded amount may differ from other counselling sessions.

Package of Care

A Package of Care would be a combination of all services allocated to the patient under the Programme. Again taking the example of Primary Mental Health:  Under the Primary Mental Health Programme, the patient may be allocated a Package of Care comprising a Counselling Service with 5 counselling sessions, a Psychology Service comprising 2 psychology sessions and a Brief Intervention Service, comprising a single brief intervention session.

Budget

Each Programme, eg Primary Mental Health, Diabetes Care Services, Mobility Services, would typically have its own budget for services. TeamCare has an extremely flexible budgeting model which allows for a number of varying budget configurations; here are some examples:

• Each practice has a number of packages of care available
• Each practice has a specified amount of funding available
• Each practice has differing amounts of funding per service eg for Diabetes Mental Health, there would be different budgets for Mental Health Credentialled Nurses; eTherapy; Flexifund etc
• Practices share a single budget across a Locality

Service Request(s)

For each service that is included in the Package of Care, TeamCare allows it to be assigned to the appropriate Provider. This can be directly from the Practice or from the Coordination Service, depending on the service and how the customer would like it to be handled.

Each Service Provider is responsible for performing initial triage and accepting or returning the service request back to the Coordination Service.

At any time, the PHO and the Practice can see whether the service request has been seen and accepted by the Provider, whether the patient has been seen and if any notes have been added by the Provider at the time of delivering the service (Provider notes are restricted from the Coordination Service).

Service requests have a number of states depending on what part of the workflow the patient has reached, making it easy to see at a glance which Provider is looking after the patient:

• Assigned – request is sitting with the Provider waiting to be opened
• Received – request has been opened but no decision yet indicated by the Provider
• Accepted – request has been accepted by the Provider and first appointment has been booked
• Returned – request has been returned to the Coordination Service and is waiting for further instruction by the Coordination Services
• Rejected – request was not appropriate
• Closed – request has been actioned

Service Delivery

Each time a Service Provider sees their patient they would record this in TeamCare. This will create a financial transaction which is included in an automatically generated IRD approved Buyer Created Tax Invoice, created at the end of the month.

Payments

PHOs pay the Providers based on the Buyer Created Tax Invoice – no manual reconciliation is required.

Hierarchies

A number of types of hierarchies exist within TeamCare:

• Service Coordination and Delivery
  • National / Regional / PHO / Coordination Service / Service Provider Organisation / Individual Service Providers
• Referrers (Who can refer / enrol into Programmes)
  • Clinic / PHO
• Billing
  • Service Provider Organisation / Business Units (GST#s) / Individual Service Providers

User Roles

A number of standard user roles exist within TeamCare:

• Oversight Role for Primary Customer contact / Manager of contract
• Administrative role / Programme Manager
  • Setup and configuration of programmes, services, service providers and users
• Financial Administrator
  • Assign and manage budgets to programmes / split by requestor
  • Access to BCTI and accounting exports
• Coordination Service user
  • Receive and manage enrolments; initial triage; create package of care for patients; assign to service providers; monitor and manage returns / delinquent requests; reject inappropriate referrals
• Service Provider Admin user
  • Receive general service requests targeted towards organisation; reassign requests from one of their providers to another
• Service Provider
  • Review and accept referrals; return inappropriate or non-contactable referrals to Coordinator; book and deliver services to patients; record service delivery

 

To see how TeamCare is used, click here