abraham george: kent year of care programme
TRANSCRIPT
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Kent LTC Year of Care Programme:
Using whole population linked
datasets to develop higher value
models of care
Dr Abraham George
Asst Dir / Consultant in Public Health
Kent County Council
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Aims
• Use whole population integrated data sets to help commissioners evaluate relative impact of different integrated care initiatives
• Use routine administration data to develop a different method of commissioning – capitated funding model – to intervene earlier, support independent living, prevent ‘crisis’ and rehospitalisation
• Use the same routine administrative data to develop a different method of payment for services which is not cost per activity but is outcomes based
• Design personal health and social care budgets to support integrated personalisation
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Setting the scope of our funding model
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Setting the scope of our funding model
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Setting the scope of our funding model
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Developing ‘currencies’ & identify potential “at risk”
cohort
• Whole population approach (SUS & provider data into local data
warehouse)
• Standard currency agreed across Kent
• List segmented by LTC currency (Bands B – E applied - B=2,C=3-
5,D=6-8,E=9+)
• Tariff to be developed for each currency band
• Risk stratification of whole population using hospital and primary
care data
• Risk Score over time mapped (looking for rise in risk score in last
3 to 6 mths)
• Multi-morbidity mapped for ‘at risk’ group across 18 Long Term
Conditions
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‘YOC Cohort’
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YOC vs Non YOC average costs
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YoC vs non YoC average costs
breakdown
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Multimorbidity profile (YoC) Cohort (n=23,600)
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Multimorbidity profile (Non YoC Cohort) (n=260,029)
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Multimorbidity profile (Whole popn) (n=283,329)
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Next steps • Increase the number of GP practices flowing data to
KMHIS
• Increase the number of providers flowing data to KMHIS
• Develop a Data Quality Improvement Plan across the system
• Work with Commissioners and Providers to develop a commissioning model in each health system
• Work with commissioners and providers to develop the contracting model to support the commissioning model
• Develop a standard set of reports and dashboards to support the monitoring evaluation of Integrated Care services across Kent
• Use linked datasets for enhanced analytics purposes (service evaluation, system modelling, economic evaluation of prevention, etc)
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