Along with her roles as Director of Strategic Programmes at Mercy Radiology and Director for Value and Innovation at Healthcare Holdings, Alexis Stewart is Programme Director at Careway. 

Careway is an ACC-funded programme to help New Zealanders with musculoskeletal (MSK) injuries get better access to healthcare.

The need for the programme arose from the musculoskeletal surgical and rehabilitation sector operating in silos on multiple unintegrated systems, says Stewart. There are high wait times for surgery and specialists. Physiotherapy copayments are between $15-$90 so most cannot afford to access the rehabilitation they need to fully recover. Many of these challenges result in costly weekly compensation payments for ACC, high reinjury rates, and poor outcomes especially for Māori and Pacific patients.

As Programme Director, Stewart has facilitated the development of the Careway programme and team. 

To date the programme has achieved:

• 28% improved access to surgery for Māori and Pacific patients
• More than 700 independent health providers connected and onboarded on to the Careway platform (physios, surgeons, sport physicians, vocational therapists, hospitals etc)
• 6000 patients enrolled (500+ enrolments a month)
• ACC has requested extension of the Careway programme into Waikato and Northland; both live in September 2022.
• 42% average increase in strength and Patient Reported Outcome Measures (PROMs) for all patients who have completed Careway programmes (from baseline)

To deliver a successful pilot, Stewart says she needed to develop an admin-light, intuitive platform that enabled excellent clinical practice. She developed the Careway platform (customised and integrated indici and thyme technology applications) with a focus on integration and automation. Launched 18 months ago, the Careway platform is now an open platform used by more than 700 busy, diverse, independent providers across Auckland. The aim is to lift the clinical bar across New Zealand and to enable all providers and not just big corporates to take part in the Careway programme, ultimately helping all New Zealanders recover from injuries faster.

“The programme is complex, but the system had to make it easy,” says Stewart. “The Careway platform is integrated with the Ministry of Health’s NHI and ACC claims APIs to prepopulate as much data as possible, reducing manual data entry and/or the amount of data that needs to be sent to the platform. Ideally, providers don’t have to leave their own systems. The Careway team achieved this integration with Gensolve (used by 600 of our physio network and who are responsible for the most datapoints) through API. Elixr and Indici system API integration went live in October 2022.”

The other patient management system providers have been more challenging to engage, says Stewart. “This has meant the Careway team had to pivot its approach. We have now achieved a good level of integration through Healthlink for other providers. There are a huge number of automated workflows triggered by actions.”

Providers can also view how they are tracking at an aggregated level against benchmarks across the programme encouraging good provider performance. Handheld dynamometers (used to take measures) can also link with the system so strength measurements are auto populated as the measure is taken.

“A big component of this has been achieved by the platform reducing the need for a large administrative workforce so that funds can be reinvested into the clinical workforce,” says Stewart. “For example, physios are sustainably reimbursed on Careway so that all physiotherapy is free – patients can access what they need, not what they can afford. The small Careway admin team is focused on supporting providers with queries, insight reporting, monitoring and management. The integrated system works quietly alongside clinicians so that they can be collaborating, monitoring and treating their patients, not filling in forms.”