Transcript Document

Mental Health Pricing and Payment
The National Picture
Sue Nowak
Head of Expanding the Scope PbR
[email protected]
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Deb Moore
Mental Health Tariff Development Manager
[email protected]
[email protected]
Overview
 The policy context
 Progress to date for the mental health payment system
and implementation in 2013-14
 What’s new for 2014-15?
 Progress in payment reform for other mental health
services
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Future of tariff
Responsibility for 2014-15 and beyond rests with NHS England and
Monitor, and the Health and Social Care Act sets out their duties:
Monitor clauses:
• General duties:
• To protect and promote the interests of people
who use health care services
• To promote provision of health care services
which is economic, efficient and effective
• To maintain or improve the quality of services
• To enable integrated care
• Monitor must also have regard to:
• Maintaining patient safety
• Desirable continuous improvement
• Commissioning fair access to services based on
clinical need and making best use of resources
• Providers cooperating to improve quality
• Promoting research
• High standards for education and training
NHSE clauses:
• Requirements including:
• To adhere to the overall budget mandated by the
SoS
• To exercise its functions effectively, efficiently
and economically
• To exercise its functions with a view to securing
continuous improvement in quality of
services
• To promote commissioner and provider
autonomy
• To reduce inequality
• To promote patient involvement and choice
• To obtain appropriate advice
• To promote innovation
• To promote integration
DH PbR team working as agents of Monitor and NHS England in 2013-14
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New responsibilities…
 From 2013/14:
1. NHS England responsible for tariff scope and
structure
2. Monitor responsible for price setting
3. Both organisations need to agree key decisions
4. DH team working as agents of NHSE and Monitor in
2013-14
 So timing of the introduction of any national tariff and
currencies for other services is the responsibility of the
NHSCB and Monitor
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Mental health funding in England
Programme Budgeting estimated England level gross expenditure for all programmes,2010/11
£ billions 2010/11 % of programme budget
Infectious Diseases
1.80
1.7%
Cancers & Tumours
5.81
5.4%
Disorders of Blood
1.36
1.3%
Endocrine, Nutritional and Metabolic Problems
3.00
2.8%
Mental Health Disorders
11.91
11.1%
Problems of Learning Disability
2.90
2.7%
Neurological
4.30
4.0%
Problems of Vision
2.14
2.0%
Problems of Hearing
0.45
0.4%
Problems of Circulation
7.72
7.2%
Problems of the Respiratory System
4.43
4.1%
Dental Problems
3.31
3.1%
Problems of the Gastro Intestinal System
4.43
4.1%
Problems of the Skin
2.13
2.0%
Problems of the Musculoskeletal System
5.06
4.7%
Problems due to Trauma and Injuries
3.75
3.5%
Problems of the Genito Urinary System
4.78
4.5%
Maternity and Reproductive Health
3.44
3.2%
Conditions of Neonates
1.05
1.0%
Adverse Effects and Poisoning
0.96
0.9%
Healthy Individuals
2.15
2.0%
Social Care Needs
4.18
3.9%
Other Areas of Spend/Conditions
25.95
24.3%
Total
107.00
100.0%
Source: Department of Health:Programme Budget National Level Expenditure Data 2010/11
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Mental health spending in England
Weighted Expenditure on Mental Health Services
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Mental health funding in the UK
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/152684/dh_130861.pdf.pdf
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The case for moving towards the
PbR type funding approach for mental health
• Mental health was the single biggest tranche of
secondary health care not covered by mandated
currencies and tariffs
• Investment around the country in mental health services
does not reflect local needs but historical block contracts
• Rising spend on acute and secure services mean that
investment on other mental health services is being
squeezed and is vulnerable to disinvestment
• Mental health services were characterised by a lack of
transparency in funding, care provision and outcomes
• Including mental health emerged as the leading
suggestion in DH consultation on future of PbR in 2007
• New approach can help support service transformation
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Mental Health PbR sits at the centre of improved
mental health services and must support current policy
Enhanced
personalisation
and choice
Reduction of
variation in
mental health
services
Value
for
money
Quality
Indicators
Mental
Health
PbR
Improved,
comparable
data
Parity of
esteem
Service
Organisation
and SLM
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Recovery
and policy
objectives
What’s been achieved nationally so far?
 Care clusters made available for use – February 2010
 Cost data collected on a cluster basis – September
2011
 All service users allocated to care clusters – December
2011
 Mental health currencies mandated for use in contracts
April 2012
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Continuing the implementation in 2013-14 (1)
 No national tariff 2013-14
 Publication of indicative prices for each cluster period
 Use of cluster period (rather than per diem) as the
contract currency
 Require providers and commissioners to rebase their
contracts on to a cluster basis and submit these local
prices centrally
 Begin to use quality & outcomes measures in contracts
 Continue to have risk-sharing mechanisms in place
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Continuing the implementation in 2013-14 (2)
(and beyond)
 National algorithm published for use and feedback during 2013 –
a decision support tool for clustering
 Working with those using the algorithm to identify any required
amendments
 Monthly MHMDS data submissions to HSCIC and reports
 Further data analysis from MHMDS for commissioners and
providers to support outcomes and quality indicators with new
tools April 2014
 Work on complexity factors to inform cluster pricing
 Work to look at alignment of clusters with diagnosis
 Work on guidance to support choice of provider policy and
payment in the absence of a national tariff
 Guidance for 2014-15 to support moving to a contract based on
cluster case load rather than income guarantee, with Q&O forming
part of the payment
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Mental Health PbR in 2014-15
 Timetable contracted for producing 2014-15 tariff
 Monitor’s National Tariff document, published
for consultation on 3 October 2013
 Final National Tariff document publication mid-December
 Changes proposed for 2014-15:
1. No income guarantee, contracts based on cluster
caseload, with risk sharing, within caps and collars
2. Guidance to support choice of mental health provider
3. Paying for quality, mandating the use of some metrics
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Local modifications
New for 2014-15 are local modifications can take the form
of agreements or applications. There are additional
requirements for applications
There are two
type of local
modifications
• Local modification agreements – agreed between
commissioner and provider
• Local modification applications – provider applies to
Monitor without the agreement of its commissioners
Conditions for
agreements
1.
Provider and commissioner agree that it is
uneconomic to provide specific services at
national price
2.
Provider and commissioner have considered
alternative means of providing the service
3.
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Proposed local modification reflects
reasonably efficient cost for the service
Additional conditions for
applications
1.
Provider has tried to reach local modification
agreement
2.
Provider cannot cease to provide the service
3.
Provider has a deficit equal to or greater than
4% of revenues at an organisational level
Local variations
These allow commissioners and providers to agree
adjustments to prices, currencies or payment approaches
where it is in the interests of patients
•
•
•
•
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The current payment system includes local ‘flexibilities’
We have updated the rules for agreeing local ‘flexibilities’, which are now
referred to as ‘local variations’
Local variations can be used to agree adjustments to prices, currencies or
payment approaches where it is in the interests of patients to support a
different service mix or delivery model. This includes:
1. bundling and unbundling of services with and without national prices;
2. delivery of care in new settings;
3. use of innovative clinical practices;
4. differences in patient casemix; and
5. arrangements to change the allocation of financial risk.
To agree a local variation, commissioners and providers must follow the
principles and the local variation must be published by the commissioner
What are the local price setting rules for 14-15?
 General rules
 Adhere to the principles of local prices (NEW)
 must be in patients’ best interests
 must promote transparency
 must engage constructively
 Have regard to NT efficiency and cost uplift factors
 Use national currency if mandated
 disclose local prices to Monitor (NEW)
 if agree not to use the national currency follow LV rules on disclosure
and publication (NEW)
 Specific rules apply to some services with nationally mandated currencies
(e.g. using the MH clustering tool). These must be followed regardless of
whether providers and commissioners deviate from using the national
currency as a basis of payment
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Development of other services
 CAMHS
1. pilots collecting data on resource usage using CYP IAPT dataset
2. some draft clusters but will be reviewed after pilots
3. currencies available in 2014/15
 Forensic services
1. Testing proposed clustering approach
2. Currencies available in 2014/15
 Learning Disabilities
1. Data collection to test clustering approach
2. Decision required on way forward
 Psychological medicine
1. Benchmarking survey undertaken further work now underway
Aim is to have alignment with the care cluster approach
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