Commissioning for outcomes. Tom Hampshire, PwC Sheena Nixon , Beacon Karen Foster, Cobic. 1. Introduction. The NHS currently faces an unprecedented set of challenges - including a potential funding gap of up to £ 54 billion by 2021/22.
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Tom Hampshire, PwC
Sheena Nixon, Beacon
Karen Foster, Cobic
OBC seeks to drive this shift towards value
Incentivising efficiency through the use of a capitated or bundled payment mechanism
Incentivising providers to innovate to deliver highly valued outcomes for patients
Outcome based commissioning
1. Population based, using a capitated approach
A provider – or group of providers – is allocated a capitated budget to manage all health needs for a defined population group.
The contract may apply to the care for a local population within a specific geography, the care for a clearly defined segment of this population, or for a group of related conditions.
These type of contracts are often referred to as COBICs - Capitated Outcomes Based Incentivised Commissioning.
2. ‘Pathway’ based approach
Commissioning a single ‘pathway’ of care, making the provider(s) responsible for a person’s outcome related to a particular condition over a specified period of time.
E.g. ‘Swedish hip’ model.
Payment may include a capitated or bundled payment for all treatment relating to that condition.
Providers are incentivised to choose the right interventionfocussing on prevention and coordinate care across the pathway.
Prioritised Outcomes According to TierOutcome hierarchy – Psychosis
Everyday activities: Extent to which I feel I am able to do activities without my illness getting in the way
Degree of autonomy: Extent to which I feel I have control over my life (managing my own finances; running my own home)
Health Status Achieved
Degree of recovery / health
Degree of physical health: Extent to which I feel I can manage my physical health with my mental health
Housing & employment: e.g. Housing, benefits & employment are in place for service user; e.g. Extent to which I feel I have safe and comfortable housing.
Time to recovery or return to normal activities
Timely Response: Extent to which I feel I have timely access to assessment & treatment; e.g. Extent to which I feel I receive help quickly so that things don't get any worse than they could have; e.g. Extent to which I feel there is time to respond to relapse plans; e.g. Extent to which I feel illness can be prevented if early signs present
Process of Recovery
Disutility of care or treatment process (e.g., treatment-related discomfort, complications, adverse effects, diagnostic errors, treatment errors)
Sustainability of recovery or health over time
Maintaining housing & employment: e.g. I keep my tenancy and employment status over time
Long-term consequences of therapy (e.g., care-induced illnesses)
Maintaining relationships: e.g. Extent to which I feel my relationships have been maintained