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Programmes » Insulin initiation - Tairāwhiti

Insulin initiation

Tairāwhiti | Diabetes | Under 18 | Over 18 | Over 65

Overview

This programme is available for people with type 2 diabetes who need to start insulin.  

The service provides funding for an initial consultation to start insulin and one follow up appointment.

This service is part of the Advanced Primary Options programme.

Your Pinnacle Services Contract applies to this service. By claiming for this service, you have indicated that you have read and agreed to the business rules set out here. 

This is NOT a clinical guideline.  

Details

Which practices can claim for this service?

Any practice in Tairāwhiti region can offer and claim for this service.

Service components
  • This programme is an inclusive one-off payment for all time spent with clinicians and supplying consumables.
  • Referrals can be initiated by a registered nurse or GP and must include related clinical notes. 
  • Only one referral per patient can be submitted. 
  • Each referral can contain a maximum of one initial and one follow up claim. 
Who is eligible for the service?
  • People with type 2 diabetes who require insulin initiation and are enrolled in a Pinnacle practice.
  • People that are eligible for New Zealand funded health care. 
  • Patients domiciled in Te Whatu Ora Tairāwhiti area.

  • Please note this funding is not available for patients starting on dulaglutide (Trulicity).
Who is excluded from the service?

People who are already on insulin and need their insulin doses titrating as part of their ongoing care, or changing their type of insulin use, are ineligible for funding under this pathway. 

Patients not domiciled in Te Whatu Ora Tairāwhiti area.

This funding is not available for patients starting on dulaglutide (Trulicity).

When is the service complete?
  • The episode of care ends when the outcome and claim are submitted.
  • Payment will be made once an outcome has been lodged for the case.
Claiming guidelines

Please note this funding is not available for patients starting on dulaglutide (Trulicity).

Initial insulin start 

  • Includes consult time and any consumables $90.00 (GST inclusive).  
  • Maximum of one per patient. 

Insulin start follow-up 

  • Includes consult time and any consumables $50.00 (GST inclusive).
  • Maximum of one per patient.  

Submit the referral including the notes for the initial insulin start consultation and use the 'invoice only' to claim the initial insulin start.

The practice will receive a reminder to close the case by submitting an 'outcome'; this can serve as a prompt to check if the patient has had their face to face follow-up consultation.

If the patient has had a follow-up consultation, submit the 'outcome and invoice' form including the follow-up consultation notes and add the insulin start follow-up claim in the invoicing section of the form. This will close the case and payment will be made. 

 

What level of clinical notes do I need to submit?

Practices are required to provide sufficiently detailed consultation notes to determine appropriate use of funding. 

Does the patient have to pay?
  • No co-payment can be charged for insulin start or insulin follow up. 
  • Any further follow up can be charged to the patient but please make sure the patient is aware of this.
How the service is funded?

The service is funded by Te Whatu Ora. 

Contact

Primary options team, Pinnacle Midlands Health Network
infoprimaryoptions@pinnacle.health.nz
027 687 7312

RELATED RESOURCES
Tairāwhiti Diabetes Manual
Published: 28/01/2022 | 1 file | Document

A guide for clinical management of type 2 diabetes, to support nurses at all levels to develop their knowledge and clinical reasoning in diabetes care.

View resource | Download files
Diabetes New Zealand
Published: 28/01/2022 | 1 link | Website

Tools, information and support for people living in New Zealand who are affected by, or at risk of diabetes.

View resource
Virtual insulin initiation
Published: 27/08/2020 | 13 files | Document | Form

Diabetes resources which will aid any virtual insulin starts by zoom/video apps that you can choose to use.

View resource | Download files
Primary Options resources
Published: 18/02/2027 | 22 files | Document

Quick guides to assist practices with identifying eligibility criteria;invoices that can be claimed; managing claims and providing assistance with understanding remittance reports

View resource | Download files
Insulin therapy for type 2 diabetes algorithm
Published: 25/05/2023 | 1 link | Document

The National Diabetes Guidelines Group has produced an insulin therapy for type 2 diabetes algorithm.

View resource
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