population level commissioning
DESCRIPTION
Population Level Commissioning for the Future Wednesday 3 December 2014, 1pm – 1.45pm Dr Abraham George Assistant Director/Consultant in Public Health Kent County Council & Beverley Matthews LTC Programme Lead, NHS Improving QualityTRANSCRIPT
WELCOME
Today’s Webinar
Population Level Commissioning for the Future
Population Level Commissioning for the Future
Wednesday 3 December 2014
1pm – 1.45pm
Dr Abraham GeorgeAssistant Director/Consultant in Public Health
Kent County Council
&
Beverley MatthewsLTC Programme Lead, NHS Improving Quality
Bev MatthewsA nurse by background, Beverley has worked extensively throughout the NHS in a variety of clinical, managerial and strategic roles. Beverley’s current role as Programme Delivery Lead for Long Term Conditions Improvement Programmes: LTC Year of Care Commissioning Model and LTC Framework. Prior to joining NHS Improving Quality in April 2013, Beverley was Director of NHS Kidney Care and NHS Liver Care.
Passionate about service transformation through developing networks and leading complex programmes. Providing strategic leadership to partners within health communities, managing stakeholders and working across agencies
Dr Abraham GeorgeWorking in Kent since 2010, undertaking a challenging portfolio focused around commissioning support for urgent care (including a unique countywide hospital bed utilization review), end of life care and older people’s health including multiple morbidities. He is also the public health lead on Individual Funding Requests, Clinical Effectiveness and Kent County lead on the JSNA and Public Health Intelligence.
Providing valuable strategic and tactical support to the Kent Integration Pioneer programme. Currently the public health lead for the Kent LTC Year of Care Commissioning Model and, alongside this, has been promoting the importance and use of person level linked datasets, enabling whole population integrated intelligence to support integrated commissioning.
Meet the Speakers
Population Level Commissioning for the Future of Care foundation.
Understanding the design and development of whole population person level linked datasets
Understanding their application towards commissioning of integrated care
What are the key challenges and inter-dependencies
• The potential impact towards whole system transformation
Learning Outcomes
Beverley Matthews
LTC Programme LeadNHS Improving Quality
Bespoke Support
Tools and Resources
LinksLong Term Conditions Dashboardhttp://ccgtools.england.nhs.uk/ltcdashboard/flash/atlas.html
Long Term Conditions House of Care Toolkitwww.nhsiq.nhs.uk/improvement-programmes/long-term-conditions-and-integrated-care/house-of-care.aspx
SIMUL8: Simulation Modelhttp://www.simul8.com/viewer/download.htm
#LTCyearofcare #LTCimprovement @NHSIQ
LTC Learning Forum
“Lunch & Learn” Webinar Series
&
Bite Size Master-classes
LTC Learning Forum
“Lunch & Learn”
• 45 minute “real time” Webinar sessions
• Topics agreed and learning outcomes identified
• Faculty of Speakers identified
Open invitation
Bite Size Learning Master-Classes
• Pre-recorded 20 minute Master-classes
• Master-class either as stand alone sessions or pre-requisites for Wednesday “Lunch & Learn” Webinars
• Faculty of Speakers identified
Open invitation
To register email [email protected]
LTC Lunch & Learn Series ….coming soon…
Date Webinar Hosted by Bev Matthews &
7 January 20151 – 2pm
Self Management Support Return on Investment
Renata DrinkwaterChief Executive & Trustee Self Management UK
21 January 20151 – 2pm
Commissioning for Outcomes Bob Ricketts CBEDirector of Commissioning SupportServices & Market Development, NHS England
4 February 20151 – 2pm
Accountable Care Organisationsin the USA & England testing, evaluating and learning what works
Dr Rachael AddicotSenior Research Fellow, Kings Fund
POPULATION LEVEL COMMISSIONING
FOR THE FUTURE
Dr Abraham George
Consultant / Assistant Director in Public Health
Kent County Council
Context
• Huge NHS and public sector funding gap
• Public sector services expected to discharge
statutory functions with ever shrinking budgets
• Growing need for ‘whole system’ understanding
how money and resources are being utilised for
population health and wellbeing
• Greater insight required to develop higher value
models of care that can meet the funding crisis
20%
75%
Context (cont’d)
40%
15%
Multiple complex conditions
Single LTC/ at risk
Healthy / minor risk
Population segments Cost
Context (cont’d)
All PbR (except YoC or
package currencies)
Acute Community Mental Health Social Care Voluntary/ Independent
Primary care
Primary care prescribing
NHS England as commissionerNon-PbR block
contract• PbR excl drugs
• Crit. Care
Personal healthcare
budget
Specialised MH Services
Means-tested
services (incl. residential)
Rehabilitation palliative & end of life
Maternity pathway
• Reablement• Adult Services
PbR MH clusters
Children’s services
GP services
Residential continuing
care
Age UK
“Shifting the focus away from reactive episodic
care, towards a proactive person centred capitated
funding model, irrespective of organisational
boundaries and disease based pathways of care”
The challenge
Local Profile
• >1.5 million population
• Governance of
commissioning at multiple
levels
• 1 County Council, 7
CCGs, 12 districts, 4
acute trusts, 1 community
health trust, mental health
trust, >200 practices
• Public Health Observatory team
• Well networked with other intelligence teams– JSNA development
– Health & Social Care Maps
– Local needs assessments
– Other analyses
• Links with K&M Health Informatics Service –data warehouse
Progress till date
• Work started in 2012 – QIPP LTC programme
• Whole population profiling using risk stratification– Burden of multiple morbidities
– Impact on service utilisation - ‘Crisis curve’
– Estimating possible financial benefits of integrated care could be realised
http://www.kmpho.nhs.uk/EasySiteWeb/GatewayLink.aspx?alId=382582
• Delivery of national YOC programme in Kent - implementation at sub Kent / CCG level
• Kent Integration Pioneer – Key milestone
• Submission of linked datasets to national team for analysis
• Contribution to national guidance eg. MONITOR report of designing linked datasets
• Currently working health informatics service to develop dashboard
Population Commissioning for the future
• Longitudinal analysis of service utilisation and
costs for a patient cohort based on multi-morbidity
/ risk stratification
• A brief look at some of the graphs and charts in
the report
Kent LTC YOC programme• All providers and commissioners involved
• 2/7 CCGs are the sponsor orgns
• KCC Public Health manages programme on behalf of whole county
• Implementation at sub Kent level
• East Kent group first to take part and now finalising shadow testing arrangements
• All professionals are involved – commissioner, finance, informatics, etc.
• Use of risk stratification dashboard to monitor activity and costs, evaluate integrated care models
• Data linkage at person level still not yet finalised, so linkage currently at GP practice level
• Risk stratification tool applied
• LTC codes applied (18 in total - QoF)
• List segmented by LTC currency (Bands B – E applied -B=2,C=3-5,D=6-8,E=9),
• Risk Score over time mapped (looking for rise in risk score in last 6 mths – 4 of 6 show an increase) or
• Rapid Riser in last 3 mths (monthly increase in risk score over past 3 mths and overall increase of >15pts).
• Kent – 80 GP practices, Band B = 2197, Band C= 3506, Band D =261, Band E= 5 Total 6369 of 729, 275
• Now driving increased engagement in risk stratification
Identifying patients suitable for YoC
The Year of Care dashboard has so far presented 4 months of activity
and costs worth £57 million from 7 different provider organisations. Of
this £4 million (7% of total spend) represents the proportionate costs
for the YOC cohort (0.3% of total population).
Issues highlightedGap Identified by Date identified Action
No standard definitions for
Integrated Care across
system
East Kent Project Group Jan 2014 Flag to West Kent
Project Group and link
to Integrated Care plan
work
No method to share care
plans once MDT completed.
(Not even seen by GPs)
EK Project Group Feb 2014 Flag to SRO
Not all practices submitting
data to HISBi
East Kent Project Group
West Kent Project Group
April 2014
May 2014
Flag to SRO
Ongoing
PLICS and RiO system in
Kent Medway P’ship Trust
not flowing data correctly
KMPT when requested to
submit first data
submission
June 2014 Resolved by KMPT
No standard definition for
integrated care within Kent
Community Health Trust
Impact identified by
Programme on YoC ability
to assess impact of LTC
services Vs WP
July 2014 KCHT to standardise
definition. Recording
process agreed Sept
2014
Variable in recording
practice of GP codes in Non
–NHS data
Programme when we
introduced “black box”
solution
Sept 2014 Highlighted to
organisations. With 3rd
sector provided list to
facilitate update.
Key Challenges
• Information Governance is a key challenge – Current approach to data sharing has been difficult – different
expert opinions on how share / link data
– National policy on data sharing for ‘indirect care’ is evolving eg. role of ‘DSCROs’, Department Health consultation on ‘Accredited Safe Havens’
• Data quality and accessibility– Good support from provider organisations
– Quality / completeness of data variable across different organisations
• Commissioner buy-in– Still some way off in application toward CCG plans
– Difficult to change mind-set of commissioning capacity towards outcomes.
– Long term planning of Business Intelligence provision in Kent uncertain
Key Messages
• Opportunity to capitalise ‘big data’ in public sector
• Importance of person level linked datasets using NHS numbers
• Using technology to accelerate the linking of data from disparate sources
• Understanding the role of intelligence to develop higher value models of care to incentivise prevention and improve population health and wellbeing
• Opportunity for business intelligence teams to work together develop whole system intelligence
Further contact details
“Year of Care is a vital component of
Kent’s Integration Pioneer Programme –
with findings being used to underpin Kent’s
Better Care Fund” Jo Frazer – Kent
Pioneer Programme Manager
- “If this works that’s my job done”
- -CCG Head of Finance
“This is the first group I have been part of that has moved so far so fast”-
AD Finance Provider
“The intelligence from YOC is both informing our thinking on a more
progressive contracting approach incentivising real service
integration”- Hazel Carpenter, Accountable Officer CCG
“Kent have been successful in linking their transformation of services
with commissioning through the LTC Year of Care programme which
will make that step towards individualised care for people with
complex needs.” Beverley Matthews, LTC Programme Lead,
NHSIQ
“The year of care programme has been a great enabler in helping us focus
upon and design a holistic ‘health and social care’ model around individual
clients rather than individual disease pathways in a value added, integrated
manner.”- Sanjay Singh Chief GP Commissioner West Kent CCG
To register email [email protected]
LTC Lunch & Learn Series ….coming soon…
Date Webinar Hosted by Bev Matthews &
7 January 20151 – 2pm
Self Management Support Return on Investment
Renata DrinkwaterChief Executive & Trustee Self Management UK
21 January 20151 – 2pm
Commissioning for Outcomes Bob Ricketts CBEDirector of Commissioning SupportServices & Market Development, NHS England
4 February 20151 – 2pm
Accountable Care Organisationsin the USA & England testing, evaluating and learning what works
Dr Rachael AddicotSenior Research Fellow, Kings Fund