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Developing Mental Health Payment by Results Systems: Project Report and Recommendations

This report from 2003 explores the complexities and challenges in developing Payment by Results (PbR) systems for mental health care. It discusses the lack of linkage between intervention and outcome, poor data, and the need to move from block contracts to improve commissioning. The report highlights the value of developing Mental Health Care Resource Groups and the importance of considering long-term needs in care provision. It also presents findings and recommendations from a project testing care clusters and classification systems in mental health settings.

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Developing Mental Health Payment by Results Systems: Project Report and Recommendations

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  1. Carole Green Project Director

  2. Mental Health PbR Developments • 2003 SECTA Report • Variation • Complexity • No link between intervention and outcome • Poor data • Worth developing

  3. National Picture • No international evidence of a system in use • No existing classification system • Mental Health Minimum Data Set completion varied • Desire to move from block contracts and improve commissioning • DH commitment to expand the scope of Payment by Results

  4. Mental Health Challenges • Value and ability to develop MH Health Care Resource Groups • Diagnosis not a good proxy for need or care package • MH more about long term needs • Health & social care joint services • Compulsion and choice

  5. Acute PbR Lessons • Diagnostic based HRG’s • Activity based currency • Intention to increase capacity/reduce waiting lists • Years to develop and refine • Transition funding to ease introduction

  6. Basis for Currency Development • Classification system based on need • Practitioner utility • Service user value and support • Incentives and innovation • Criteria for a currency • Resource homogeneity • Ability to implement • Data collectable • Resilient to gaming

  7. Care Pathways & Packages Development • Self selecting group of interested providers • Shared local experiences and models • Approaches to improve quality and consistency of care provided • South West Yorkshire MH Trust Model • Implemented in practice

  8. InPAC • Clinical Decision Support Tool • Standard Needs Assessment Tool • Empirically derived care groups • Standardised Care Plans • Standardised aims of interventions • Standardised activities

  9. Basis for MH PbR • Initial testing across 6 provider sites in Y&H and NE • Scope WAA • Do the clusters (care groups) appear in other provider sites? • Does the standard needs assessment tool work? • Can the data be collected? • Can the classification system be used as the basis for PbR?

  10. Project Findings & Recommendations • 95% service users allocated to a cluster • Similar profiles of cluster allocation across sites • Practitioners utility demonstrated • Data able to be collected • Desire to expand on a needs basis to Older Peoples services • Significant support to extend to develop model for PbR

  11. Consultation on Future of PbR • CPPP report used to inform the national consultation • MH identified as top area for increasing the scope • CPPP Consortium formed 2008 • Key objectives • National currency • Local tariff • Quality indicators and outcome measures

  12. Key Outputs of the Project • Classification system underpinning currency model • Standard needs assessment tool • Cluster groups as basis for currency • Initial costing work and local tariff development • Developing quality indicators and outcome measures • Main development site supporting ongoing refinement

  13. Local Models of Integration Care Planning Cost Improvement Programme QIPP Access and Choice Clinical Governance, Q & O Currencies for MH PbR Commissioning Workforce Development Service Line Management Service Planning/Redesign

  14. National Timescales • 2010/11 – The MHCT and clusters are available for use. • - Reference costs returned on a cluster basis. • 2011/12 – • - All service users accessing mental health care (post GP or other • referral) that have traditionally been labeled working age (including • early intervention services from age 14) and older people’s services, should be allocated to a cluster by 31 December 2011. • - Local prices should be agreed for use in 2012/13 and this will require understanding of local costs per cluster

  15. National Timescales • 2012/13 – The clusters (with local prices) become mandatory for • contracting and payment purposes. • 2013/2014 – The earliest possible date for a national tariff for mental • health (if evidence from the use of a national currency presents a • compelling case for a national price).

  16. C P P P DECISION TREE (RELATIONSHIP OF CARE CLUSTERS TO EACH OTHER) Working-aged Adults and Older People with Mental Health Problems C Organic A Non-Psychotic B Psychosis a Mild/ Moderate/ Severe b Very Severe and complex a First Episode b Ongoing or recurrent c Psychotic crisis d Very Severe engagement a Cognitive impairment 1 2 3 4 5 6 7 8 10 11 12 13 14 15 16 17 18 19 20 21

  17. Currency Local National National Tariff Local Local National PBR Development Process: Step 1 2 3

  18. Describing the elements of a currency

  19. Complex ongoing cases

  20. Data Warehouse Based on the most recent data issued the warehouse contains: - • Over 5m community activity records (contacts) • Records are held on over 433k patients • Almost 184k care review records (CPA reviews)

  21. Stage 2 Stage 3 Stage 1 Stage 4 Calculate Determine Calculate the Relative Model options weighted period cost per Value Unit For draft tariff durations day Staged costing process

  22. Quality & Outcomes National approach Outcomes and indicators cluster specific Pragmatic and developmental Replace CQUIN, link with current agendas Service user, clinical, performance C P P P

  23. Key Linkages • IAPT, Forensic, CAMH’s, LD, Addictions • Personalisation, QIPP • Operating Framework, Standard contract, • Reference costs, MH commissioning • Incentives & Best Practice

  24. Next Steps & Issues • Activity Collection – volume & quality • Accuracy of Clusters • Algorithm • Training, support and awareness raising • Assessments • Commissioner input / capacity • Financial implications • shadow arrangement • Speed of implementation • Payment mechanism • More unknown……but better than we have now

  25. Contact Details www.cppconsortium.nhs.uk Office: 01482 389123 Mobile: 07984 630079 Email: carole.green@humber.nhs.uk

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