Transcript Slide 1

CPPP
Care Pathways and Packages Project
Developing currencies for mental health payment by results
Carole Green
Project Director
CPPP
Care Pathways and Packages Project
Developing currencies for mental health payment by results
Mental Health PbR Developments
• 2003 SECTA Report
• Variation
• Complexity
• No link between intervention and outcome
• Poor data
• Worth developing
CPPP
Care Pathways and Packages Project
Developing currencies for mental health payment by results
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
CPPP
Care Pathways and Packages Project
Developing currencies for mental health payment by results
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
CPPP
Care Pathways and Packages Project
Developing currencies for mental health payment by results
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
CPPP
Care Pathways and Packages Project
Developing currencies for mental health payment by results
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
CPPP
Care Pathways and Packages Project
Developing currencies for mental health payment by results
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
CPPP
Care Pathways and Packages Project
Developing currencies for mental health payment by results
InPAC
• Clinical Decision Support Tool
• Standard Needs Assessment Tool
• Empirically derived care groups
• Standardised Care Plans
• Standardised aims of interventions
• Standardised activities
CPPP
Care Pathways and Packages Project
Developing currencies for mental health payment by results
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?
CPPP
Care Pathways and Packages Project
Developing currencies for mental health payment by results
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
CPPP
Care Pathways and Packages Project
Developing currencies for mental health payment by results
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
CPPP
Care Pathways and Packages Project
Developing currencies for mental health payment by results
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
CPPP
Care Pathways and Packages Project
Developing currencies for mental health payment by results
Local Models of Integration
QIPP
Care Planning
Cost
Improvement
Programme
Access and
Choice
Clinical
Governance,
Q&O
Currencies
for MH PbR
Commissionin
g
Workforce
Development
Service
Planning/Redesign
Service Line
Management
CPPP
Care Pathways and Packages Project
Developing currencies for mental health payment by results
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
CPPP
Care Pathways and Packages Project
Developing currencies for mental health payment by results
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).
CPP
P
DECISION TREE
(RELATIONSHIP OF CARE CLUSTERS TO EACH OTHER)
Working-aged Adults and Older People with Mental Health Problems
A
B
C
Non-Psychotic
Psychosis
Organic
a
b
a
b
c
d
a
Mild/
Very
Severe
and
complex
First
Episode
Ongoing
or
recurrent
Psychotic
crisis
Very Severe
engagement
Cognitive
impairment
Moderate/
Severe
1
2
3
4
5
6
7
8
10
11
12
13
14
15
16
17
18
19
20
21
PBR Development Process:
Step
Currency
Tariff
1
Local
Local
2
National
Local
3
National
National
Currency Model
Activity
(intervention)
Cluster Algorithm
Mental
Health
Clustering
Tool
Care Transition
Protocols
Quality Indicator 1
£
Quality Indicator 2
Quality Indicator 3
Quality Indicator 4
21
Clusters
Resource
utilisation
(Tariff)
Quality
Indicators
1
2
3
Describing the elements of a currency
Currency representation
Cluster
Weighting
Duration
Period end
Period
start
Complex ongoing cases
Currencies and care transition points
Care Transition Points
Periodic Review
Unscheduled Review
Cluster 10
Cluster 8
Period start
Period end
Period end
Period start
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)
Staged costing process
Stage 2
Stage 1
Calculate the Relative
Value Unit
Calculate
weighted
cost per
day
Stage 3
Determine
period
durations
Stage 4
Model options
For draft tariff
Quality & Outcomes
•
National approach
•
Outcomes and indicators cluster specific
•
Pragmatic and developmental
•
Replace CQUIN, link with current agendas
•
Service user, clinical, performance
CPP
P
CPPP
Care Pathways and Packages Project
Developing currencies for mental health payment by results
Key Linkages
• IAPT, Forensic, CAMH’s, LD, Addictions
• Personalisation, QIPP
• Operating Framework, Standard contract,
Reference costs, MH commissioning
• Incentives & Best Practice
CPPP
Care Pathways and Packages Project
Developing currencies for mental health payment by results
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
CPPP
Care Pathways and Packages Project
Developing currencies for mental health payment by results
Contact Details
www.cppconsortium.nhs.uk
Office: 01482 389123
Mobile: 07984 630079
Email: [email protected]