Colegio

In the community or NGO mental health sector, contracts for service between the funder (the DHB) and the provider are the main mechanism for ensuring the timely and

appropriate delviery of high quality mental health services. Contracts or “Agreements” are generated and managed by the Agreement Administration Team of HealthPAC Dunedin, a national processing centre and information repository (Ministry of Health 2002c). HealthPAC is made up of three teams. The agreement team generate agreement documentation (i.e. contracts for services), enter contract and service details into the Contract Management System (CMS), generate templates for providers and enter performance data when reports are received. The payments team enters invoice data to enable the accurate and timely payment of providers (Ministry of Health 2002c). These two teams are supported by the third team, Information Management, who provide ad hoc reports from then HealthPAC systems.

The Agreement Administration Team is also responsible for maintaining the CMS, a system which, according to the Ministry of Health “manages the whole funding process from drafting and finalising agreements through to monitoring provider performance and service delivery” (Ministry of Health 2002c).

The Agreement Administration Team liaise with DHB contracts managers to produce agreement documents and maintain information about these agreements. Agreements are standard legal documents and include information on the term of the agreement, services purchased, price, volume, payment information (such as schedules and invoice amounts) and monitoring information (Ministry of Health 2002c). Agreements are prepared using generic or master agreements, which contain standard sections and clauses. They normally include the following sections:

General Terms and Conditions; Provider Quality Specifications;

Information and Reporting Requirements Service Specifications; and

Provider Specific Terms and Conditions. (Ministry of Health 2002c)

The first three sections include information that is standardised across the mental health sector. Depending on the type of service being provided, the relevant service specification will be added (e.g. for a kaupapa Māori mental health service the relevant specification from the National Framework would be added to the Agreement). The last section, Provider Specific Terms and Conditions, will contain the payment schedule, the

price-volume schedule (the services the agreement is for; the volumes to be purchased; the price per unit, if appropriate; and the total price for each unit), and any changes negotiated to the standard sections of the agreement (Ministry of Health 2002c). Contracts tend to be volume-based (payment based on a maximum number of interventions and funding capped at that level), or paid on a fee for service basis (Lavoie 2004).

The Agreement Administration team are also responsible for the tasks associated with the performance monitoring of providers, including receiving logging and entering data from providers, following up on overdue reports, providing aggregated data reports (such as volumes and variance reports) for contract managers and key stakeholders, and checking the performance monitoring requirements contained in the service specifications (Ministry of Health 2002c).

HealthPAC are able to monitor each contracted service using the Monitoring Module function of the CMS (Ministry of Health 2002c). Monitoring data can be used by both the provider and the contracts manager to check progress against the contract. Reporting templates are generated from the monitoring system and providers can report on these templates electronically via email or by filling out a paper copy. There is an expectation that reporting and data collection should go straight to the Agreement Administration Team rather than to contract managers at the DHB. Only by exception should providers report to the Contract Manager and then the Agreement Administration team must be notified. Once the reports have been submitted, a standard letter is generated to acknowledge receipt of the report, and the information is entered into the Monitoring Module (Ministry of Health 2002c). If reports are overdue, not completed or deliberately withheld, HealthPAC can withhold part of a provider’s payment, as per the terms of the standard contract.

The CMS system is able to generate reports for Contracts Managers, however the types of reports that can be generated are mainly volume reports, variance reports, lists of providers who were overdue on their reports and other similar information (Ministry of Health 2002d).

accountability and performance measurement frameworks has led many nations, including New Zealand, to investigate the development of reliable and accurate outcome measures, long regarded as the holy grail of performance indicators. In New Zealand a range of frameworks, regulations, guidelines and acts of Parliament control and prescribe how mental health services are to be delivered with contracts being used as the key mechanism for funding mental health services in the community and for reporting on performance. These contracts tend to be volume-based or paid on a fee-for-service basis and do not as yet, include outcome measures. Nor do contracts encompass more culturally appropriate measures of health service provision, despite the availability of various culturally relevant models of performance measurement. It was the realisation that the contracts used in Māori mental health may not be compatible with the way Māori mental health providers deliver their services that that led to the conceptualisation and development of the research questions which have guided this project.