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The New Healthcare Economy:

The New Healthcare Economy:. Information Challenges. Toby Lambert, Director of Strategy and Policy Neil Stutchbury, Knowledge Management Director. Regulatory mechanisms for influencing integrated care. Toby Lambert Director of Policy and Strategy. Monitor (incl. CCP) . Professional

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The New Healthcare Economy:

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  1. The New Healthcare Economy: Information Challenges Toby Lambert, Director of Strategy and Policy Neil Stutchbury, Knowledge Management Director

  2. Regulatory mechanisms for influencing integrated care Toby Lambert Director of Policy and Strategy

  3. Monitor (incl. CCP) Professional regulators Care Quality Commission Protection of the public and patients Department of Health NHS Commissioning Board NHS Trust Development Authority Health and Social Care Act 2012

  4. Monitor is changing Monitor (pre 2012 Act) Monitor (post 2012 Act) Responsible for FT assessment, governance and financial oversight Main duty: to protect and promote the interests of people who use health care services Monitor is changing

  5. Monitor’s main duty will be to protect and promote . . . • Section 61 • (1) The main duty of Monitor in exercising its functions is to protect and promote the interests of people who use health care services by promoting provision of health care services which • Is economic, efficient and effective, and • Maintains or improves the quality of the services • (2) In carrying out its main duty, Monitor must have regard to the likely future demand for health care services ‘Promote’ implies enhancing all performance; could be the focus for sector regulator ‘Protect’ implies a minimum standard that Monitor enforces; could be the focus for FT regulator Interests of people who use healthcare Interests are a measure of value – outcomes that matter to patients (i.e., quality) / cost

  6. Mission ‘Enabling providers and commissioners of NHS care to deliver the best possible care for patients today and tomorrow through publishing information, using incentives and enforcement where necessary’

  7. New provider licence obligationsIn force from 1 April 2013 (FTs only) General Integrated Care Pricing Choice and Competition Governance for FTs Continuity of Services

  8. Integrated care Information • What works in integrated care? • What costs are incurred? Incentives • What are the most appropriate currencies? • How do we structure prices? Enforcement • How can regulators enforce integrated care?

  9. Timeline Risk Assessment Framework Department of Healthconsultations HSCAassent Opportunity forSecretary of Stateveto January 2013 October 2013 Spring 2012 Summer 2012 Summer 2012 Late 2012 April 2013 April 2014 Enforcement Guidance Provider licence consultation FTslicensed Competition powers go live Other providerslicensed First Monitor/ NHSCB national tariff Guidance for commissioners on Commissioner Requested Services Management of risk pool to be consulted on in 2013 Today

  10. Monitor's Information Strategy: Harnessing technology to influence beneficial patterns of care Neil Stutchbury Knowledge Management Director How Monitor’s existing responsibilities are supported by information management Monitor’s new information strategy to support the new duties on economic regulation How Monitor’s information strategy benefits patient care

  11. Assessments and Transactions connect2: Assessment connect2: Licencing Portal Board report docs approval Board meeting NHS Trust Financial analysis Benchmarking Governance and quality assessment Pipeline views Issue licence and set up FT in connect2 • Benefits to patients • Assurance that their trust meets the financial, quality and governance standards they would expect of a well run hospital Future developments • Improve benchmarking using new data warehouse and modelling tools

  12. Provider Regulation connect2: Compliance + SQL db Monitor website Quarterly & annual plan templates Portal Board report approval Board meeting Foundation trust Publish quarterly risk ratings and annual plan review Financial risk assessment Governance and quality risk assessment Regulatory opinion and actions Benefits to patients • Foundation trusts continue to be well led and meet quality and governance standards • Failing trusts are identified early and corrective steps applied quickly to prevent failure Future developments • New financial and governance risk framework for ensuring compliance to licence

  13. Licencing connect2: Licencing Online Application Applies for licence Download licence Portal Goes live before 1/4/14 Went live on 1/4/13 Portal Download licence Registered provider of NHS funded services Foundation trust • Creates complete licence from FT details and standard licence conditions • Creates PDF and puts it in the portal Benefits to patients • The legal framework which assures patients that healthcare will be delivered in a way that best represents their interests and is done so economically, efficiently and effectively Future developments • Joint licencing system with CQC for new entrants will be live from 1/4/14

  14. Pricing, Competition, Enforcement This requires a fundamentally different approach to data analysis and management The Pricing function needs to create costing and pricing models which accurately reflect how care is delivered. We will trial a new approach to costing based on patient level costs (PLICS) for the 15/16 tariff The CCP transitioned into Monitor on 1 April 2013. It analyses local health economics data to investigate claims of unfair competition, for example GP referral patterns and the impact of commissioning behaviour on travel times The Enforcement regime acts to protect essential services for patients in the event of failure. To do so it needs to model the impact of different service reconfigurations on the local economy and patient choice

  15. Pricing, Competition, Enforcement A big change in number of organisations and the sources of information that Monitor will need

  16. Pricing, Competition, Enforcement A big change in the volume, type and sources of data, and the way in which it will be used

  17. Proposed Information Architecture Tools Use of Tools Data Quality feedback loop from Monitor functions Statistical Modelling & Analysis Cost / Pricing Models Data Warehouse Bespoke Applications Data Validation Data from HSCIC E.g. HES, PROMs, ESR, MHMDS, CDS etc. Impact Assessment Models Dashboard Reporting Data from other sources E.g. Maps, Census etc. Competition Models Regular Reporting Data from providers E.g. finance, quality, PLICS Provider Regulation Tools Ad Hoc Reporting data not meeting quality criteria and requiring rework, and/or resubmission The means to track and manage data quality Central repository of managed data to source regulatory requirements Applications, models, analyses, reports for each business function. Using a range of tools for different uses

  18. Common Information Model Common Information Model Monitor can easily collect today Data exists and is available with the right contracts/IG etc Data may exist but may not be complete or easily available Over the next 3 years, the strategy is to turn every box on this model green We will need to work with partners to do this, e.g. Health and Social Care Information Centre

  19. Roadmap 2013-14 2014-15 Pricing: • Cost model • Pricing engine • Impactass’ment • Incentives Competition: • Referral patterns • Travel times • Local market analysis • Patient choice Supporting information and technology capabilities Assessment and Compliance: • Benchmarking trust performance • Risk modelling • Financial analysis Enforcement: • Service reconfiguration • Economic analysis • Impact on patients 2014-15 2015-16

  20. Overall Information StrategyVision: Information-led healthcare regulation Providers Patients, public… Strategic imperatives: • Single entry / exit point for data and information • Unified data storage / manipulation environment • Advanced modelling and analysis of the data • Expanding role of the KIM Team (scale and capability) • Mature internal governance and controls • Partnering with HSCIC, NHSCB, CQC, NICE, NTDA to access data and promote quality and standards Portal interface Website (gov.uk) Intranet Document mgt Collaboration SharePoint (2010 to 2013) Contacts Enquiries, FOI… Case management CRM (v4 to 2011) Data warehouse Data validation Modelling, stats, reports SQL Server (‘08 to ‘12) and/or Cloud + BI/modelling tools Data suppliers eg HSCIC, Google, ONS

  21. Conclusion: The Benefits to Patients • Our mission is to protect and promote the interests of patients, for example: • Confidence that hospitals are well run and meet acceptable quality and governance standards • Preventing hospitals from failing by spotting issues early and remediating them • Prices are set such that providers are incentivised to improve quality and efficiency • Encouraging providers to link services together for the benefit of patients • Enabling patients to exercise their right to choose how their healthcare needs are met • The system will allow efficient services to replace poor or inefficient services • Protecting essential services for patients and reconfiguring failed providers • We cannot fulfil our regulatory responsibilities without accurate and timely information • We are implementing a new information strategy for the benefit of patients

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