hugh reeve: how is the nhs in cumbria adapting to lessons from the alternative quality contract?
Post on 14-Jun-2015
1.143 Views
Preview:
DESCRIPTION
TRANSCRIPT
Hugh Reeve
Chair: Cumbria Clinical Commissioning Group NHS Cumbria
How is the NHS in Cumbria drawing on lessons from the Alternative Quality Contract?
In 2007 we embarked on a journey In March 2011 this took us to Boston, Massachusetts
Insurers Tufts Health Plan Blue Cross Blue Shield
Providers Atrius Health (multispecialty IPA) Mount Auburn and Cambridge IPA
(multispecialty) and Mount Auburn Hospital Hampden County IPA (primary care only)
These 3 providers all had extensive experience with risk based contracts
Key take-aways from BCBS Contracts for the whole continuum of care, over 5 years
allowing time for the “tanker to turn” For organisations to hold an AQC a primary care provider
with sufficient patient base is essential to participation Risk (gain) share between insurer and provider, determined
by quality performance Financial incentives promote affordability and efficiency Performance incentives promote quality, safety and patient
centred care (process, outcomes and patient experience measures)
Significant investment by insurer in supporting AQC providers (10-12 WTE middle to senior managers)
Key take-aways from Providers New paradigm of global risk based contracts (not just the
AQC) – “keeping my population healthy” Investment in areas that previously wouldn’t have
generated income Health coaches, case managers, hospitalists Data management systems + data analysis – clinician
performance, hospital utilisation rates, prescribing, and imaging and lab rates
Electronic Medical Records
Strong clinical leadership and a culture of independent physician practices working together
Partnership with BCBS Regular performance feedback and support Collaborative, long term commitment in a 5 yr contract
Collaboration with hospitals – formal and informal partnerships, drives value throughout the delivery system Atrius Health: “We want to use hospitals that enable us to integrate our specialty
care into the fabric of the hospital to the greatest extent possible”
MACIPA and Mount Auburn Hospital: Managed care partners since 1985 with history of investing in
systems and programmes to manage costs Strong, long term relationship between the two senior leaders Each are independent entities with no joint legal structure Contracts with insurers signed separately as three-way
agreements and all parties at the table in discussions Risk share between IPA and hospital is defined and agreed
outside of the contract with insurers
Cumbria CCG
Carlisle
Eden
Furness South Lakeland
Allerdale
Copeland
Commissioning Support Services
A networked commissioning group in 2011 across a 500,000 population
Immediate actions (0-6 months) 2011/12 contract
50/50 split on any underspend on 11/12 PBR element of contract
Risk share on elective activity – marginal rates for activity 0.5% or more above plan
Risk share on non-elective admissions as nationally This signalled a new style and approach
Primary care One CCG with devolution to six localities
Immediate actions (0-6 months) 2011/12 contract
50/50 split on any underspend on 11/12 PBR element of contract
Risk share on elective activity – marginal rates for activity 0.5% or more above plan
Risk share on non-elective admissions as nationally
Primary Care One CCG with devolution to six localities Secondment of support staff to localities – data
analysis, referral support, medicines mx, project mx Roll out single EHR (Emis Web) across general
practice, community services and community hospitals
Medium term (6-18 months) Develop our own narrative – culture, leadership
and a new paradigm (“keeping you healthy”) Honest discussions with partners (health, social
care and 3rd sector) about new ways of working Develop capacity within primary care
Workforce – doctors, nurses, HCA’s, Mx, new roles Industrial scale long term condition management Education and training QOF+ incentives using Local Enhanced Services
But long term … the real prize is clinically led, multi-specialty groups taking on accountability for the whole continuum of care.
CCG “Payer”
Carlisle
Eden
Furness South Lakeland
Allerdale
Copeland
A central “Payer” with a network of Provider Federations
South Cumbria
North East Cumbria
Provider Federations
GP Practices
Out of Hours
Community Specialists
Support Services
Consultants, nurses, therapists, etc. Existing and new roles
Back office, Ed/Training, Audit, etc
Community Beds
Day care & Day case
Multi-specialty groups
Stand alone or joint ventures
Accountable for whole continuum of care – “make or buy”
Contracts that promote efficiency and high quality
Lessons from the AQC?
Our current contracts for both general practice, community services and specialist services need a radical overhaul.
Make change voluntary not compulsory; but make staying still an increasingly difficult place to be.
Perhaps our real challenge is creating a primary care infrastructure fit for the 21st century.
This is a 10-15 year programme – will our lords and masters have the courage to let it happen?
top related