outcomes based commissioning
TRANSCRIPT
Joint Commissioning Collaborative
Making outcomes that matter
Introducing outcomes based commissioning in
Richmond
Jacqui Harvey, Accountable Officer, Richmond CCG
Cathy Kerr, Director of Adult & Community Services,
Richmond Council
4 December 204
Joint Commissioning Collaborative
Changing how we commission community services
• Fragmentation of services and how they are accessed
undermines patient experience.
• Staff feel the way the service is commissioned and managed
gets in the way
• Many GPs experience the current service it in a way which is
almost random. GP referral patterns, usage, experience and
satisfaction all vary widely
• The current commissioning contract does not enable the CCG to
fully meet its goals to improve patient health and service
outcomes.
The case for change :
Joint Commissioning Collaborative
Community health services
Joint Commissioning Collaborative
Traditional commissioning …
• Commissioning based on activity levels as proxy for outcomes
… or finance as proxy for activity
• Attempts to control activity and processes regardless of patient
need
• Creation of perverse incentives
• Preserves fragmentation
• Tendency to over-specify or mis-specify
• Not aligned with what patients want
Joint Commissioning Collaborative
Outcomes based commissioning• Relatively new approach to commissioning health and
social care services in the UK
• Rewards both value for money and delivery of better
outcomes
• Requires a change in the “currency” underpinning
contracts
• Moving away from process and activity measures
• Greater use of indicators of patient outcomes
Joint Commissioning Collaborative
An ‘outcome’ refers to the impacts or end results of services on a person’s
life
What is an outcome?
Outcome-focused services aim to achieve the aspirations,
goals and priorities of service users or patients.
Joint Commissioning Collaborative
What are the benefits of OBC?
Increased focus on
whole-person care
1
Enabling
collaboration and
integration
2
Realising efficiencies
in the system
• OBC aligns incentives across the health
and social care to deliver the outcomes that
matter to patients and the public.
• Rewards outcomes and not just activity -
OBC puts resources in the right place in the
system to maximise value
• OBC means providers are supported, and
incentivised, to work together to deliver
whole-person care
• Improved patient and service user
experience through reduced fragmentation
of services and improved models of care
• OBC is focused on improving the quality of
whole-person care, but evidence suggests
that it can also result in efficiencies of 10-
15%
• Promotes investment in prevention and
more effective and efficient working
practices
• Can reduce duplication across the system
• Opportunities to deliver care in lower cost
settings
3
Joint Commissioning Collaborative
Developing outcomes for Richmond – the story so far
• Community research and engagement and outcomes
development
• Mapping current services and analysis of “as is”
• Starting to look at what a new model for community
services would look like
Joint Commissioning Collaborative
Next steps for outcomes based commissioning in Richmond
Jacqui Harvey, Accountable Officer, Richmond
CCG
Cathy Kerr, Director of Adult & Community
Services, Richmond Council
4 December 204
Joint Commissioning Collaborative
Two stage process to achieve an OBC contract for community services and
out of hospital care across health and social care
• Stage one: To enhance the 2015/16 contracts and move providers towards
an OBC approach.
• Stage two: To let a more complete OBC contract for community services
and out of hospital care from April 2016.
• These recommendations have been agreed by the OBC Programme
Board and Richmond CCG Governing Body.
Two steps to 2016/17
Joint Commissioning Collaborative
Moving towards OBC and enhancing 2015/16 contract
Health
Prevent
-ion
Primary
Care
Mental
Health
Acute
care
Social
Care
Current HRCH
community
services
including (not
exhaustive):
• District
nursing
• RRRT
• Diagnostics
• Rehabilitation
• MSK
• Diabetes
• Podiatry
• Paediatric
services
Community and out of hospital services Service providers
Community
Services
• HRCH
• Your Healthcare
Acute Care
• Kingston Hospital
• West Middlesex University
Hospital
• Chelsea and Westminster
Hospital FT
Mental Health
South West
London and St
Georges
Social Care
• E.g. could be
nursing home
& residential
care providers
Primary Care
• GPs
• Richmond
GP Alliance
Joint Commissioning Collaborative
Working towards a community and out of hospital
services contract in 2016
Health
Prevent-
ion
Primary
Care
Mental
Health
Acute
Care
Social
Care
Current HRCH
community
services including
(not exhaustive):
• District nursing
• RRRT
• Diagnostics
• Rehabilitation
• MSK
• Diabetes
• Podiatry
• Paediatric
services
Community
Services
• HRCH
• Your Healthcare
Community and out of hospital services Service providers
Acute care
• Kingston Hospital
• West Middlesex University
Hospital
• Chelsea and Westminster
Hospital FT
Mental health
• South West
London and
St Georges
• East London
Foundation
Trust
Social care
• E.g. could be
nursing home
& residential
care
providers
• Voluntary
sector
Primary care
• GPs
• Richmond
GP Alliance
Joint Commissioning Collaborative
Outline contents of Re-commissioning launch document issued by CCGs:
May 15 June 15 April 16
Release assessment
criteria
Route A: Coordinating provider development
Contract
commencementCapability
Assess 1
Pass
Capability
Assess 2
Pass
February 15 December 15
Release future contract for capability
assessment 2
Route B: Open market procurement
Fail Fail
Timeline for 2016/17 OBC contract
Joint Commissioning Collaborative
Impact on patients
• Patient outcomes are the basis of care plans
• Patients have more information with which to make
decisions
• People can do more self-management and self-care
• Greater emphasis on prevention and early
intervention
• More care delivered at or near home
• Better value for money