iapt pbr workshop 20 july 2017 - yhscn.nhs.uk health/iapt pbr/1. yh i… · iapt payment...
TRANSCRIPT
www.england.nhs.uk
• Andy Wright, IAPT Clinical Advisor, Rebecca Campbell, Quality Improvement Manager and Sarah Boul, Quality Improvement Lead
• [email protected], [email protected] and [email protected]
• Twitter: @YHSCN_MHDN #yhmentalhealth
• July 2017
Yorkshire and the Humber
Mental Health Network
IAPT PBR Workshop
20 July 2017
www.england.nhs.uk
@YHSCN_MHDN
#yhmentalhealth
Housekeeping:
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Yorkshire and the Humber
Mental Health Network
Welcome, Introductions and
Aim of the Workshop
Andy Wright, IAPT Advisor,
Yorkshire and the Humber Clinical Networks
www.england.nhs.uk
IAPT Payment Implementing an
outcomes-based payment
approach for IAPT
Sue Nowak | Head of Pricing Development
Pricing Team, Strategic Finance, NHS England
[email protected] | 0113 824 9353
Robert Melnitschuk | Pricing Development Manager
Pricing Team, Strategic Finance, NHS England
[email protected] | 07730 37 53 45
20 July 2017
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Strategic context Five Year Forward View for Mental Health
• Recommended payment system that will increase transparency in the payment system and support improvements by linking payment to quality and outcome measures
Increased transparency
• “…the continued use of unaccountable, ill-defined, block contracts by mental health commissioners is detrimental to patient access to mental health services” IMHSA Policy Paper…”
Move towards commissioning based on quality and patient outcomes rather than historical service provision.
• “…payment mechanisms that enable person-centred approaches to care and parity between physical and mental health. Payment agreements for mental health services are to be transparent, consider the needs of patients and ensure accountability…”
Enhancing quality through allocative efficiency
• Using the payment system to incentivise adoption of practice that promotes sustained recovery, in the most appropriate setting
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2017/19 national tariff and IAPT payment
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From April 2017 commissioners and providers should be
shadow testing an outcomes-based payment approach
By April 2018 commissioners and providers should have
implemented an outcomes-based payment approach
Local pricing rule 8 requires:
• the adoption an outcomes-based payment approach
• use of the 10 national outcome measures collected in the
IAPT data set
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• Transparent
• Framework for commissioner-provider discussions
• Support improved quality and outcomes
• For service users, providers and local systems
• Appropriate incentives
• Recognises activity, case-complexity and
outcomes
IAPT payment approach key principles
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• Nature of the payment approach
• Share learning between areas
• Outcome measures information
• Thresholds
• IAPT payment and outcomes tool
• Delivery, testing and expansion
• Non-mandatory prices – useful?
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Updating the guidance
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National IAPT payment approach
Aims:
1. To reimburse providers for the costs of providing evidence-based
episodes of treatment
2. To reward providers for performing well against agreed quality and
outcome measures
Total IAPT payment per
episode Assessment
Cluster-based episode of treatment
Basic service price component
Outcomes component
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• Local prices for an assessment and a cluster-based
episode of treatment
Basic service price (activity)
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Intensity of treatment by cluster
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Costs by cluster
Cluster weighted average cost £619.94
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Cluster 1
£x
Cluster 2
£y
Cluster 3
£z
Cluster-based episode of treatment
price
• Commissioners and providers should agree cluster prices to cover the
efficient costs of delivering evidence-based IAPT episodes of treatment
• Price levels can also be adjusted to incentivise activity in relation to
people with a specific complexity of need in response to local priorities.
Cluster 4
£p
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Performance price (outcomes)
• Locally weighted 10 national quality and outcome
measures linked to payment
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Value of the outcomes component
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• Our guidance with NHS Improvement recommends the value of the
outcomes component being set at a minimum of 5% of contract value
initially.
Activity component
95%
Outcomes component
5%
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• Local pricing rule 8 requires the use of the 10 national measures:
1. Waiting times (Access)
2. Black, Asian and minority ethnic (BAME) (Access)
3. Over 65s (Access)
4. Specific anxieties (Access)
5. Self-referral (Access)
6. Clinical outcomes
7. Reduced disability and improved wellbeing
8. Employment outcomes
9. Satisfaction (Patient experience)
10. Choice of therapy (Patient experience).
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10 national quality and outcome
measures
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Cluster 2
£y
Cluster 3
£z
Quality and outcome weightings
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• Commissioners and providers should agree quality and outcome
measures weightings in line with local priorities
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High level operational flowchart
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Monthly
activity and
outcomes
data
Monthly
submission
to IAPT
minimum
dataset
Monthly
payment
calculation
Quarterly
reconciliation
Business
rules ie risk-
sharing
mechanism
Monthly
payment
Quality and
outcomes
measures
Finance envelope
(monthly plan)
Annual activity
(monthly plan)
Prices and quality
and outcomes
thresholds (set
annually)
Assessment Price
Quality and
outcome
measures
Relative outcome
weightings
Annual activity and
finance plans
Cluster based
episode of
treatment prices
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• Shadow testing in 2017/18
• Bringing together payment approach and
contracting
• IAPT service model
• Use of care clusters
• Stepped pathway shared between providers
• Data quality
• Price Setting
• Gain/loss share
Implementation considerations
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Step 12: Understand the root cause of
any differences.
From the comparison work in Step 11,
ensure that the cause of all differences
are understood. Step 5: Create an output to test!
For testing to begin, there needs to be
something to test! This should be an early
iteration of the new payment model.
1. Planning / Design 2. Simulation 3. Shadow
4. Live
Step 1: Define the aim of the testing
project and the overall scope.
This should be informed by the initial
proposals to form a new care model.
Step 2: Agree on a new payment model.
Given the new care model, identify the
payment approach which will best deliver
the aims. Local payment leads, NHS
England or NHS Improvement can all help
with this decision.
Step 3: Identify the key stakeholders to
be involved and those who will make
decisions based on the model’s
performance during testing.
Who is leading the testing and who is
setting the agenda for it.
Step 4: Agree on the areas to assess.
Be clear on what answers are required
from testing. This will provide steer on
what areas will need to be assessed.
Know what constitutes success and
failure.
Step 6: Process historical data through
the new payment model.
This is a practical step which will start to
confirm or refute some of the
expectations formed during the design of
the new payment model. It won’t wholly
reflect reality, but it will give a good
indication about performance.
Step 7: Will it be physically possible to
implement the new payment model.
Termed ‘Infrastructure Capability’ in the
guidance. This is when testing should be
carried out to gauge whether the
resources and physical infrastructure are
in place to enable the new payment
model to perform.
Step 8: Make further adjustments and
refinements to the new payment model.
Collate the results for Step 6 & 7 and
evaluate them. Do they suggest that any
amendments are needed.
Step 9: Process current, live data
through the new payment model.
The main step. Parallel running of the
current and proposed payment models
- using the same inputs - to better
assess any differences between them.
Step 10: Consider all the potential new
arrangements.
Assume the new payment model is in
use. Discuss what changes there may
be and act out or role-play the
situations which may arise.
Step 11: Make comparisons with the
existing payment model.
Collate all the new information and
compare it to existing processes.
Step 13: Continue to test the new
payment model while it is in use.
This promotes continual testing and the
allowance for further modifications to the
new payment model if required. There
may be initial teething problems which
further testing can help resolve.
Step 14: Refine and begin a ‘version 2’ if
needed.
If Step 13 provides evidence that changes
are required, put in place plans to action
these. Have discussions about next steps
and whether further iterations of the new
payment model may be needed.
Step 15: The old model is retained as
back-up.
It might be prudent to retain the old
model in some form in case it is needed.
Unforeseen circumstances may cause
issues with the new payment model and
the old model can be a useful ‘safety net’.
A general framework for
Shadow Testing
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• Local Implementation via Cloud Architecture –
Microsoft Azure
• Reduced burden of infrastructure for providers
• Dedicated Resource
• Ready Access
• N3 not necessary
Deployment of IAPT Currency Tool –
Interim State
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National implementation via integration with Data Flow
at HSCIC Bureau Services Portal (Exeter)
• Embedded in National Infrastructure
• Allows for pre-deadline testing of provider data
submissions
• N3 connection needed
Deployment of IAPT Currency Tool –
End State
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• 2017/19 national tariff published requires areas to implement an
outcome-based payment approach by April 2018
• Payment approach should use the 10 national outcome and
quality measures, but there may also be metrics which are locally
important
• NHS England and Improvement have published guidance on an
outcomes-based payment approach which has two components:
1. Activity
2. Outcomes
• NHS Digital have been commissioned to provide a tool to support
implementation
• We can provide other resources which will help you to shadow
the impacts of a new payment approach in 2017/18
Summary
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Questions?
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Quick Comfort Break
10 minutes only please!
IAPT Tariff Tool
presented by Kit Hadley-Day
Information Design Consultant
IAPT Tariff Tool
• Who am I?
• What has happened so far?
• The Tool
• The Data
• Implementation
• Getting ready for the tool
• Questions
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What is the National Casemix Office
• Responsible for creating the Hospital Resource
Groups used for costing and pricing the activities
performed in hospitals
• Produce the freely available grouping software used
throughout the physical acute service
• Provide ‘Patients to Pound notes’ costing and tariff
modelling and analysis
• For more information visit the website
http://content.digital.nhs.uk/casemix
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Project History
• Tool has been in development for several years
• Issues with funding and developer resource has
caused delays
• Recent collaboration between Birmingham CrossCity
CCG, NHS England and NCO has provided focus and
highlighted required changes to the tool
• These changes have been rapidly developed to make
the tool comply with the published outcomes-based
payment for IAPT services guidance
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What is the IAPT Tariff Tool
• Developed in collaboration between NHS England
and the National Casemix Office
• It is driven from the current IAPT data set (version 1.5)
• Consistent with guidance on an outcomes-based
payment approach for IAPT services covering:
– Activity component (assessment and episode of treatment)
– Outcomes component (10 national quality and outcomes
measures)
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Current Data Collection
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• Eight tables containing
• Appointment data
• Patient data
• Referral data
• Assessment Data
• Treatment Data
• Submitted via the Exeter Portal
Building the Input
• Tool input is a flat file built from the existing 1.5
dataset after it is processed by Exeter
• NCO Input file is currently produced by the NHS
Digital Mental Health Team, as the internal asset
owners
• It is produced to a specification containing business
rules on how source tables should be linked and
resolving any ‘fuzzy’ connections
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Outputs
• Appointment level output
– This contains all the data that was submitted to the tool along with additional fields, derived by the tool, to help understand how the model has been applied to individual records
• Pathway level output
– This contains the summary information for each completed period of care (pathway)
– Details of the targets for the model, if they have been achieved and the final tariff calculations and outcomes
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Tool Implementation
• User assurance cloud service, currently in development.
This is a beta service with limited numbers of users to
get feedback on the model and tool functionality
• Full cloud service accessed through the Exeter Portal to
be made available to whole service as soon as
information governance and cyber security testing is
completed
• Integration into the current flow of the IAPT data set,
currently being developed in Exeter
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Cloud Service
• User data made available after final processing by
Exeter – no need to upload your own data
• Users will have the ability to change any of the tariffs
and targets that drive the model to allow for
meaningful analysis of the impacts of contract
negotiations
• Produces outputs in formats ready to be uploaded into
a database or analysed in Excel
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Exeter Implementation
• Integrates the tool logic into the current national data
flow
• Will automatically apply the current agreed targets and
tariffs to data as part of final processing
• Outputs will be available via the Exeter Portal besides
the currently created extracts
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Time Line for delivery
• Test Cloud – This should be available from the beginning of August to
‘Trailblazers’ who have agreed to early access to the tool for evaluation purposes, we expect this to be about fifty users. This will be populated with synthetic data
• Full Cloud Service – This service should be on line and open to the whole service by
the end of the year, all efforts are being made to make this available as soon as possible
• Exeter Integration – This is aimed to be available from the beginning of the next
financial year.
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Preparing for the Tool
• Data quality is vital to ensure accurate reimbursement
calculations
• The tool requires a fairly large amount of reference
data to accurately define the terms of the model, this
data will need to be collected in advance of the
system go live.
• Become an early adopter, feedback from the service is
vital to improving the tool.
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Any Questions
?
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Time for some lunch?
Back in 1 hour please!
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Yorkshire and the Humber
Mental Health Network
Provider Presentation: IAPT as an AQP
Andy Sainty, Service Manager – Humber NHS
Foundation Trust Emotional Wellbeing Services
(IAPT)
IAPT as an AQP
Spoiler ALERT!
Block Contract paid for 12 Therapists (9 wte)
Long Waiting Lists
Unable to fund further staff
Present
IAPT as an AQP
Current State
Moved from Block Contract to AQP Tariff 1st April 2014 (21+ tariff values) Commissioned to provide 7 service lines Population size of just over 333,000* Geographical patch just under 10002 miles - mainly rural Provide to more than 1 CCG under separate contracts* Under AQP we now have over 60 Therapists
Service Lines & Tariffs
Service Delivery • NICE Stepped Care Model - fully compliant with IAPT model • Currently 60/40 split between 3rd Party and Self Referrals but Self Referrals
increasing monthly
• 49 Main venues across East Riding + Group Venues
• Mode of Delivery - Face to Face/Telephone/Online
Cluster 0 - 21
IAPT as an AQP
HOW?
Capacity & Demand Theory
Demand is all the requests and referrals coming in from all sources
Capacity is the resources available to do the work. This includes all
equipment (rooms) and the staff hours available to treat or patients.
Activity is all the work done. It is the actual clinical work carried out by
clinical staff.
Natural variation: Is not within our control but can often be predicted
• Differences in presentation that patients present with • The socio-economic or demographic differences between patients • Seasonal variation • Staff skills
Artificial variation: A large part of artificial variation is within our control
• The way we schedule services • The working hours of staff and how staff leave is planned • The order in which we see and treat patients • How much work we group and deal with in ‘batches’ • How we manage waiting lists
Normal Variation : There are ups and downs in new referrals (demand)
and in our available capacity but in most cases they are predictable.
The model helps you to: • Understand your demand and also the variation in demand • Understand your current service • Understand the core capacity you genuinely have available to see patients and the ad hoc / flexible capacity you rely on to deliver the service The model will provide: • An estimate of the capacity you need to meet your demand • An estimate of the backlog that may need to be cleared to sustainably deliver national and locally agreed waiting times standards
CCG Access Rates*
• Previously commissioned for less than 10% and have worked on increasing this over last two years.
• Currently meeting 15% on regular basis (14 patients short of 15% at last published data from NHS England) and target is 18.6% from 1st April 2017
Referrals (not including Direct Access)
Waiting Times
Outcomes
DNA Average 6.7% for 2015/16
Patient Satisfaction >= 95% and closer to 100% if anomalies* are removed
Waiting Times 6 & 18 Week Standard
• Multiple access points • E-Referral • Telephone • Fax/Letter • Short Text code • Direct access to Groups
• App available via Android/iTunes for patients to enter OM’s – more therapy time • Groups – SC/LAS/LAHA/BA/Worry/Panic/Sleep • Pathways from
• DWP • Dual Diagnosis Services • LTC – bespoke groups for CoPD/Respiratory/Stroke/CVD/Diabetes • Secondary care • Perinatal
• Online appointment booking – coming soon
Basics
Challenges • AQP – no guarantee of income revenue • Capacity/Demand • Choice & venue – costs • Organisational Risk - Waiting Lists if no capacity from other
providers • Training • Diversity • Marketing – bus story • Recruitment – but not retention • Do more for less culture
Research www.iaptprn.com
Involved in various research projects • ETR/LRI • Stress Control • TDS • ReQol • Others applied for but going through ethics
BROKERAGE MODEL?
Future
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Yorkshire and the Humber
Mental Health Network
Questions and Answers
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Discussion and Action Planning
1. What are the main challenges for
implementing PBR in IAPT services?
2. What are the key next steps and actions
for you and your organisation?
3. What support do you need to deliver on
your next steps and actions?
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Yorkshire and the Humber
Mental Health Network
Closing Remarks and Next Steps
Andy Wright, IAPT Advisor,
Yorkshire and the Humber Clinical Networks
www.england.nhs.uk
Yorkshire and the Humber
Mental Health Network
Thank you for Attending!
Please remember to fill out your
evaluation forms!