Commissioning integrated care insights from our research
This presentation is the property of its rightful owner.
Sponsored Links
1 / 15

Commissioning integrated care: insights from our research PowerPoint PPT Presentation


  • 93 Views
  • Uploaded on
  • Presentation posted in: General

Commissioning integrated care: insights from our research. Dr Judith Smith Head of Policy, the Nuffield Trust Professor Chris Ham Chief Executive, the King’s Fund 22 September 2011. Agenda . The research project Case studies of commissioning integrated care Emerging themes

Download Presentation

Commissioning integrated care: insights from our research

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Commissioning integrated care insights from our research

Commissioning integrated care: insights from our research

Dr Judith Smith

Head of Policy, the Nuffield Trust

Professor Chris Ham

Chief Executive, the King’s Fund

22 September 2011


Agenda

Agenda

  • The research project

  • Case studies of commissioning integrated care

  • Emerging themes

  • Policy implications


The research project

The research project

Project aim

  • To understand how NHS commissioners were using their leverage to develop more integrated care

  • To examine the extent to which such attempts were focused on efficiency, as well as service quality

  • To consider what this means for commissioning in economic hard times, and in the new reform context


The research project 2

The research project (2)

Project approach

  • A questionnaire survey of all PCTs in October-November 2009, seeking information about innovations in commissioning

  • A survey by email and phone of SHA commissioning leads

  • Approaches to national organisations

  • Use of an expert advisory group

  • Review of US literature on payment reform

  • Case studies of innovative examples of commissioning, developed via research visits and interviews, and review of documents


The research project 3

The research project (3)

What we thought we might find

  • Commissioning care pathways rather then episodes of care via Payment by Results

  • Commissioners working with lead providers to promote integration, and the use of subcontracting by these lead providers

  • New forms of payment to incentivise integration, such as payments for care pathways and other forms of payment bundling


The research project 4

The research project (4)

What we found

  • PCT survey had a disappointing response, despite a follow-up chaser

  • Survey of SHAs, and discussions with advisory group and national organisations added some examples

  • Overall, most examples were provider-initiated, and it was difficult to find ones that were led actively by commissioners

  • We drew up a long list of examples, from which a number of case studies were selected


Case studies of commissioning integrated care

Case studies of commissioning integrated care

  • Birmingham North and East PCT – commissioning integrated care for people nearing the end of life

  • Milton Keynes PCT – seeking to contract an ‘accountable care organisation’ for a whole programme of care

  • Tower Hamlets PCT – commissioning outcome-based diabetes care from networks of providers

  • Smethwick Pathfinder – a group of GP practices holding a capitated budget for managing the care of people with long-term conditions


Case studies of commissioning integrated care1

Case studies of commissioning integrated care

  • Cumbria PCT and practice-based commissioning – commissioning integrated diabetes care across a county, using a new specialist care organisation

  • Knowsley PCT – contracting with a lead specialist provider to deliver the full range of cardiovascular care for a population with major health inequalities

  • Somerset PCT – commissioning an integrated COPD service from a partnership of BUPA and a company formed of local GPs

  • West Kent PCT – commissioning a social enterprise to deliver integrated out-of-hours primary care and emergency primary care, based in the hospital A&E


Emerging themes the cycle of commissioning

Emerging themes – the cycle of commissioning

  • Needs assessment and service specification – took up considerable time and resource, helped with engagement, but hard to move to implementation

  • Contracts – a range of mechanisms used, including PMS, GMS and adaptations of PbR and acute contracts. Seems there is more potential to use existing mechanisms

  • Tendering and procurement – costs of this were prohibitively expensive in some cases, yet others were able to contract for new forms of care across organisations

  • Outcomes and incentives – the value to be had from linking payment to expected outcomes, and doing this in a phased manner


Emerging themes facilitators of new approaches

Emerging themes – facilitators of new approaches

  • Managerial leadership – senior support, drive, and risk-taking

  • Clinical leadership – as commissioners and providers

  • Primary care-led commissioning – PBC as a catalyst for service review, redesign, and change

  • Data and IT – critical to contracting, tracking outcomes, developing sophisticated payment approaches


Emerging themes facilitators of new approaches 2

Emerging themes – facilitators of new approaches (2)

  • The registered list of patients – important for population-based approaches and budget-holding

  • Provider engagement – it is costly for providers to be involved, and a risk for them

  • Time and persistence – takes a lot of time and resource to plan and implement major change


Policy implications

Policy implications

  • Central support for commissioning of integrated care is vital

  • The role of Monitor will need to be crafted in a way that promotes both competition and integration

  • There is a need for further and more extended experimentation with tariff and incentives for integrated care

  • A range of approaches to contracting and procurement will be needed


Policy implications 2

Policy implications (2)

  • Some GP commissioners will want to be able to ‘make’ as well as ‘buy’, and policy on conflicts of interest will need to address this

  • There is a need to think again about how the commissioner-provider split might operate in future, perhaps testing out new integrated provider-funder organisations

  • In whatever approach, aligning incentives across primary and secondary care, and also social care, will be vital


To conclude

To conclude

‘ The balance of risks and incentives placed on commissioners and providers in the NHS appears at present to be wrong. Commissioners seek to develop more population-focused and preventative approaches to care [...] yet providers remain incentivised to increase activity and expand services within their organisation.

Perhaps the strongest message from this research is that PCTs have struggled to put providers sufficiently at risk in relation to developing better integrated and more efficient care.’

Ham, Smith and Eastmure, 2011, p35


Commissioning integrated care insights from our research

www.nuffieldtrust.org.uk

Sign-up for our newsletterwww.nuffieldtrust.org.uk/newsletter

Follow us on Twitter(http://twitter.com/NuffieldTrust)

© Nuffield Trust


  • Login