Redesigning Elective Services

Redesigning Elective Services

This page provides an overview and updates about a current programme of work to redesign Elective Services – the Elective Services Pathway Programme.

Our goal

To deliver clients the right treatment and services, when and where they need them, for the best possible result, in a cost-effective, efficient way.

What are Elective Services?

We contract individuals and organisations in the public and private health sector to provide our clients with additional assessment and treatments following an injury. These Elective Services include:

  • Clinical Services
  • High Tech Imaging (HTI)
  • Elective Surgery Services
  • Pain Services
  • Rehabilitation Services.

What is the Elective Services Pathway Programme?

The Elective Services Pathway Programme was formally established to scope and analyse potential solutions, then focus on an agreed service re-design.

The re-design will allow us and our providers to achieve the best possible outcomes for people needing Elective Services following injury.

The Programme focuses on re-designing our three main Elective Services contracts: Clinical Services, HTI and Elective Surgery Services.

Elective Services Review

We started with a review of our Elective Services in 2013-2014, following our clients’ progress through the health system, from beginning to end (‘client pathway’).

The review examined primary, allied and secondary care services, client and service delivery outcomes, funding and procurement. Wider issues, such as the workforce required for injury treatment, information technology needs, and information sharing between providers, ACC and clients were also examined.

The review team confirmed that the way Elective Services are currently being delivered can create barriers to seamless treatment and rehabilitation for clients. This resulted in a new ACC Elective Services strategy and programme of work.

Elective Services Review: Achieving better outcomes for people needing Elective Services following injury, December 2014 (PDF 2MB) (external link)

Elective Services Pathway Programme

In November 2014, our Board agreed to the Elective Services Pathway Programme, a three-year programme of work to improve treatment and rehabilitation services.

It will put the client first and deliver measurably better health outcomes for greater value.

Six work streams have been established to address the challenges and opportunities identified by the review. They are:

  1. Outcomes
  2. Funding
  3. Service integration
  4. Communication
  5. Improving ACC’s business processes; and
  6. Workforce.

Elective Services Strategy (PDF 559K)

The above link goes to an image of the Electives Services Strategy which has been summarised onto one page.

It refers to the Elective Services vision, the scope, and aim.

It also includes the six work streams and eight guiding principles.

What’s next?

This is a three phase programme. It is in the early stages of Phase 3, which is expected to take three years, and will focus on:

  • Detailed scoping of the proposed solutions
  • Development of solutions
  • Identifying how we will implement the solutions.

Elective Services Pathway Programme phases (PNG 35K)

The above link goes to an image of the programme’s three phases: review, initial scoping and analysing of solutions, and re-design.

The last phase of the programme is expected to end in 2017.

Why re-design Elective Services?

Our review identified, among other things, that:

  • we currently put processes before people so our clients and providers often have a fragmented, ‘siloed’ experience with many unnecessary inefficiencies and obstacles
  • our current approach does not support an integrated service model as services have often been designed and purchased in isolation from each other, nor does it always reflect evidence based, best practise care for our clients
  • we, and our contracted providers of Elective Services, have limited visibility of the outcomes achieved and the quality of services purchased or delivered
  • our current funding framework is neither transparent nor sustainable. Projected care, treatment and rehabilitation demand will outstrip current supply
  • the Elective Services workforce is under pressure, and we can do more to influence and shape the resources needed to deliver quality outcomes for our clients
  • our communication with clients and providers about Elective Services is incomplete, complicated or delayed.

We spend some $500 million each year on purchasing Elective Services for our clients. Of that, almost $300 million a year goes towards Elective Surgery Services - our single, largest health spend. Our surgical and medical spend grew by approximately 79% between 2006 and 2014 – an almost 10% increase a year.

By 2026, the number of hip replacements and total knee replacements in New Zealand is projected to increase by 84% and 183% respectively (source: New Zealand Medical Journal, vol 127 (1401). Our current funding and pricing model is not sustainable if this rate continues.

As an example of why we are re-designing Elective Services, have a look at the New Zealand Medical Association’s study on current trends and projections in the utilisation rates of hip and knee replacement in New Zealand from 2001 to 2026 (external).

Elective Services client journey and spend (JPG 78K)

The above image identifies the number of claims per annum, and the total cost, for each of the elective services.


We have chosen to focus on six work streams because:

  • research demonstrates that receiving quality treatment when and where it is required leads to the best possible health outcomes
  • effective contract management, underpinned by outcomes measurement, coupled with evidence-based, best practice clinical pathways supports the delivery of the right treatment at the right time
  • quality indicator and outcomes measurement provides the means to determine if clients are receiving quality care, and that this care is delivering best possible health outcomes
  • integrated services put the client first, makes the best use of limited health resources and improves clients’ experience and health outcomes
  • financially sustainable services contribute to the longevity of the scheme, ensuring that clients, now and in the future, can access necessary care.

Keep in the loop

We’re keen to hear from anyone interested in being part of the redesign process.

If you’d like to get involved or stay informed, follow the updates published here, get in touch with your professional organisation, or email us at and subscribe to our mailing list.

Stakeholder updates

Elective Services Pathway Programme update – December 2015 (PDF 181KB)

Contact us

You can email us at

Updated: 21 December 2015