Evaluating integrated care at Macquarie University’s Centre for the Health Economy (MUCHE)

The Macquarie University Centre for the Health Economy (MUCHE) is based in Sydney, Australia. It is a University led strategic initiative to undertake innovative research on health, ageing and human services. Established in 2014, our vision is to create a world where decision makers are empowered with applied, trusted and influential research. MUCHE consists of specialist health economists working in multi-disciplinary teams across a broad spectrum of health economics and public health related topics. We collaborate across University faculties and with leading University research centres in the US, Europe and Asia. We also work with government and non-government partners committed to funding independent research on the health economy.

One of MUCHE’s strategic research areas (pillars) is integrated care. We are undertaking a number of projects that combine methodological innovation with applied economic evaluation. Here is an overview of five key projects currently in progress.

1. Economic Evaluation of the LifeSpan Program (2017 -2021).
This research program is being undertaken in collaboration with the Black Dog Institute and is funded by a charitable grant provided by the Paul Ramsay Foundation. LifeSpan is a systems-based integrated suicide prevention program that involves nine strategies being simultaneously implemented in local areas across four sites in New South Wales. These sites are the Central Coast, Newcastle, Murrumbidgee and Illawarra/Shoalhaven. MUCHE will be providing an economic evaluation of the cost-effectiveness of the intervention on reduced suicides and reduced suicide attempts.

2. Economic Evaluation of the Central Coast Local Health District’s (CCLHD) ‘North Wyong Proof of Concept’, Outcomes based care program (2017 -2018)
The CCLHD Integrated Care Demonstrator site incorporated a new model for funding Outcomes based care. Community providers working with older vulnerable communities were incentivised to deliver their own care coordination model. Provider payments were linked to the level of funding risk chosen by a provider, and their capacity to reduce unplanned acute hospital bed days for their patient cohorts. MUCHE is providing the economic evaluation of the CCLHD’s Outcomes based care program. There are three parts to this evaluation: a process evaluation of the Outcomes based care program, an evaluation of the CCLHD contestability approach using the NSW Treasury framework for evaluation, and a cost-effectiveness analysis of the funding model aimed at reducing unplanned hospital admissions.

3. The ‘use and usefulness of outcomes based funding models for hospitals’ (2017- 2018)
This research was commissioned by the Sax Institute in 2017. It explores international evidence and context regarding the definition and intended outcomes for value-based care in publicly-funded hospitals. Additionally, it evaluates: different design features of funding model schemes (e.g. size of risk-related incentives in contractual negotiations); measures of effectiveness designed into the funding model; intended and unintended consequences of contractual obligations; and the implications for public funding and for commissioning more broadly in Local Health Districts in New South Wales, Australia.

4. Methodological research around mapping the relationship between EQ-5D, AQOL-8D and the PROMIS 10 questionnaire (2018)
The validated PROMIS Global Health 10 survey instrument is commonly used as a self-report tool to explore physical and mental health outcomes for people with chronic illness. The domains and attributes that PROMIS explores includes depression; anxiety; physical function; pain interference; fatigue; sleep disturbance; and ability to participate in social roles and activities. We are undertaking a mapping exercise between PROMIS Global Health 10 and the more commonly used EQ-5D instrument. The EQ-5D is a standardized instrument developed by the EuroQol Group as a measure of health-related quality of life that can be used to estimate quality adjusted life years (QALYs). The instrument comprises five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. The AQOL-8D is an equivalent tool used to estimate QALYs using Australian tariffs. Successful mapping between the instruments will reduce the burden of data collection for study participants and will allow cost-utility analysis to be conducted, a preferred approach for decision-making in health economic evaluation.

5. Academic partnership in the ‘Digital Health Cooperative Research Centre’ Program. (2018-2025)
The Digital Health Cooperative Research Centre’ Program is a Commonwealth grant for Aus$55 million matched to another Aus$55 million from industry contributions. It is a consortium of many industry and other research partners. MUCHE’s role is to evaluate integrated care in the digital health space as the program develops. More specifically to evaluate
• Integrated care platforms delivering patient-centred, and hybrid models of care that change client behaviour and care or disease trajectories
• Digital health support in linking primary and acute care, with a focus towards more appropriate management for population cohorts with chronic diseases and rehabilitation recovery.

Liz Schroeder is a Senior Research Fellow at the Centre for the Health Economy, Macquarie University (MUCHE) in Sydney, where she leads the Integrated Care stream of research. She holds a doctorate in Public Health from the University of Oxford, and brings to IJIC unique expertise from both the UK and Australian contexts.

Liz’s interests sit primarily in mixed methods approaches to evaluating integrated care, blending process and economic evaluations and incorporating innovative measures to determine financial impacts and value based outcomes. Her vision is to support collaborations between researchers, clinicians, health economists and health service planners to ensure high quality embedded implementation and translational research. She aims to attract research to IJIC designed to identify feasible, sustainable, cost-effective and scalable initiatives at local or regional levels to serve as indicators of success. In addition, she is looking for methodological papers to improve outcomes measurement, financing and funding models and high quality evidence in evaluation.

Liz will be working closely with IJIC editors, Apostolos Tsiachristas and Viktoria Stein to develop these research streams.