Long Term Conditions
Year of Care
Commissioning Programme
Bev Matthews - Programme Delivery Lead
Jamie Day - Healthcare Fi...
Context
•
•
•
•

15m people with Long Term Conditions
Increasing each year with ageing population
Responsible for 70% of N...
Driving Policy through
Funding Instruments
• A year of care capitation fund for a person living with
multiple conditions
•...
Silo treatment vs. whole person

Sir John Oldham, DH
What if?
• We plan care for people rather than disease?
• Are there common patterns of service use?
• Can we differentiate...
Background

 Launched in June 2012 under Dept of Health QIPP programme
 Transferred to NHS England in December 2013
 SR...
Early Implementer Sites
Health Economy Early
Implementer

Key Partners

Regions

Leeds

Leeds South and East CCG, Leeds We...
Benefits
Improved outcomes and wellbeing:
•
•
•

Patients receive care that is better managed, more seamless across differ...
Data Collections
Recovery, rehabilitation & Reablement clinical audit:
 To support local thinking about RRR and early dis...
Early Implementer Sites Deliverables
•
•
•
•
•
•
•
•
•

Stakeholder engagement and senior team „buy-in‟
Assessment of serv...
National Support Team Deliverables
•
•
•
•
•
•
•

Senior team „buy-in‟, eg NCDs
Stakeholder Engagement, eg Monitor and PbR...
Using Simulation to Drive Changes in
Health and Social Care –
LTC Year of Care Commissioning
Programme
Agenda
• What is simulation?
• Why use it in
healthcare?
• Learning from the data
• Simulating long term
conditions for th...
Where does simulation help?

• Modelling uncertainty
• Testing assumptions and their consistency when no
historic data
• C...
Our task

• Create a simulation model
• 7 pilot sites
• 1 national model to be used locally
Looking for common parameters
What is simulation and why use it?
Models a flow of events
Small scale
operations
Service
operations
Whole
system

Passing...
A simple simulation

Patients come into a clinic for treatment
They arrive every 5 minutes
The treatment takes 10 minutes
...
A simple clinic – a typical week
Benefits of simulation

Risk- Free

Uses data
intelligently

More
accurate than
a
spreadsheet

Models
variability

Increas...
Planning for Healthcare
How long
What is my
What are
is it
How much How much
demand
my
can I
reasonable
resource
likely to...
Starting to simulate a new approach

Patients at Risk

Assessment of Need

Exacerbation
Services “consumed”
But……

• No real correlation between risk score and level of need

Patients at Risk
Assessment of Need
What the data is telling us
Over 30% of people over 75 years
have multimorbidity

Kent whole population data
Multimorbidity is more common than
single morbidity

Kent whole population data
The total health and social care cost
is strongly related to multimorbidity

Kent whole population data
The main contributors to total health
& social care cost are acute nonelective admissions

Kent whole population data
People with complex health & social
care needs appear to demonstrate a
‘crisis curve’

Kent whole population data
More community, mental health and
social care services are delivered to
people following a ‘crisis’ than
before the ‘crisi...
Some indications that an integrated
care plan changes the pattern of
services delivered to people

BHR costing data
Implications
• Evidence suggests that once people with complex care needs (multimorbidity) are
identified, the services de...
Current Simulation
• Likelihood of patients accessing services by changing
state of patients
– Level of acuity
– Increasin...
How it works

• Patients in each “state” have
– A likelihood of accessing certain types of service
(Acute, Community, Ment...
Results
• Number of patients in each “state” by year
• Costs by state per year
• Comparison with locally determined tariff
Testing, testing…

• Beta being tested with site data for year 2
• Comparing patients cared for by integrated care teams o...
What the simulation does…

• Informs question development and data collection
• Allows experimentation and hypothesis test...
@NHSIQ
enquiries@nhsiq.nhs.uk
www.nhsiq.nhs.uk

Improving health outcomes across England
by providing improvement and chan...
“Integration is a means to an end;
the purpose is about better person
centred care and better outcomes –
it‟s about
privil...
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Using simulation to drive changes in health and social care

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Using simulation to drive changes in health and care - long term conditions Year of Care model
Bev Matthews and Claire Cordeaux
Presentation from Day 1 of the Health and Care Innovation Expo 2014, Manchester Central

Published in: Health & Medicine
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  • Talk through the simulation in this part-vary arrivals
  • Using simulation to drive changes in health and social care

    1. 1. Long Term Conditions Year of Care Commissioning Programme Bev Matthews - Programme Delivery Lead Jamie Day - Healthcare Finance and Information Specialist Claire Cordeaux - Executive Director, SIMUL8Healthcare
    2. 2. Context • • • • 15m people with Long Term Conditions Increasing each year with ageing population Responsible for 70% of NHS costs Significant cause of ED attendance and urgent admission
    3. 3. Driving Policy through Funding Instruments • A year of care capitation fund for a person living with multiple conditions • Incentivizing providers and commissioners to work effectively together • Aligning funding flows and patient need for support • Improving outcomes and efficiency • Reducing emergency care activity
    4. 4. Silo treatment vs. whole person Sir John Oldham, DH
    5. 5. What if? • We plan care for people rather than disease? • Are there common patterns of service use? • Can we differentiate groups of patients by need and costs to create an annual tariff? • Can we work within that tariff to reduce emergencies and manage care out of hospital? • Where should we intervene to stop progression to multiple long term conditions?
    6. 6. Background  Launched in June 2012 under Dept of Health QIPP programme  Transferred to NHS England in December 2013  SRO is Dr Martin McShane, Director Domain 2  7 Early Implementer Sites  22 Fast Followers
    7. 7. Early Implementer Sites Health Economy Early Implementer Key Partners Regions Leeds Leeds South and East CCG, Leeds West CCG, Leeds North CCG, North Southend Southend CCG; Southend Council Midlands and East Kent Kent County County (Social Services Dept), Kent Community Health Trust, East Kent University Hospital FT, Maidstone Foundation Trust, Darent Valley Hospitals FT, Canterbury CCG, Thanet CCG, Swale CCG, Ashford CCG, South Kent Coast CCG, West Kent CCG, Dartford and Gravesham and Swanley CCG. South North Staffordshire and Stoke on Trent Stoke on Trent CCG, North Staffordshire CCG; Stoke on Trent Council; Staffordshire Joint Commissioning Unit; University Hospital of North Staffordshire; Staffordshire and Stoke on Trent Partnership Trust, North Staffordshire Combined Healthcare Trust; West Midlands Ambulance Trust Midlands and East West Hampshire West Hampshire CCG; Hampshire County Council; Hampshire Hospitals NHS FT; Southern Health NHS FT. South Barking, Havering and Redbridge Barking and Dagenham CCG; Havering Emerging CCG; Redbridge Emerging CCG; Barking & Dagenham Council; Redbridge Council; Havering Council; NHS Outer North East London; Barking, Dagenham and Redbridge University Hospitals Trust; North East London NHS FT. London Kirklees North Kirklees Emerging CCG; Greater Huddersfield CCG; Kirklees Council; NHS Calderdale; Mid Yorkshire Hospitals Trust, Calderdale and Huddersfield FT; Local Community Partnership; South West Yorkshire Partnership; Kirkwood Hospice. North
    8. 8. Benefits Improved outcomes and wellbeing: • • • Patients receive care that is better managed, more seamless across different care services and more needs focused. Reduction in acute admissions to hospital; and shorter lengths of stay when these are required. Clinical professionals contribute to a more holistic service for patients by working within an integrated patient-centred care plan Local health & Social Care economies: • Provide care that delivers value for money and is better managed by integrated teams. • Incentive to improve services for patients • Improved joint working and shared responsibility for outcomes
    9. 9. Data Collections Recovery, rehabilitation & Reablement clinical audit:  To support local thinking about RRR and early discharge, particularly in relation to potential for pathway changes.  To assess the appropriateness of methodology for long-term conditions (COPD, diabetes, stroke and heart failure), particularly whether there is scope to unbundle the RRR service from the Acute Provider PbR tariff. Costing dataset  Support the development of local tariffs for LTC YoC currency  Looking at longitudinal data to support the discussions/understand the impact in changing pathways Whole Population  Gives the evidence to support the currency framework  Validates the framework
    10. 10. Early Implementer Sites Deliverables • • • • • • • • • Stakeholder engagement and senior team „buy-in‟ Assessment of services to maximise the benefit of integrated care Learn from research, eg models of care, contracting models, weighting LTCs for local tariff Planning for improvement in data quality and implementation of shadow testing Assessment of systems and processes to support YoC currency RRR clinical audit Local analysis and collection of data to support national analysis Local tariff development Share learning with other health economies and national stakeholders
    11. 11. National Support Team Deliverables • • • • • • • Senior team „buy-in‟, eg NCDs Stakeholder Engagement, eg Monitor and PbR Team Framework for the Model and vision for future years SIMUL8 Model for redesigning services Data analysis and comparison Programme Management and EI site support Resolution of barriers, eg Information Governance
    12. 12. Using Simulation to Drive Changes in Health and Social Care – LTC Year of Care Commissioning Programme
    13. 13. Agenda • What is simulation? • Why use it in healthcare? • Learning from the data • Simulating long term conditions for the Year of Care
    14. 14. Where does simulation help? • Modelling uncertainty • Testing assumptions and their consistency when no historic data • Considering variability • Driving thinking • Sharing models
    15. 15. Our task • Create a simulation model • 7 pilot sites • 1 national model to be used locally Looking for common parameters
    16. 16. What is simulation and why use it? Models a flow of events Small scale operations Service operations Whole system Passing of time Arrivals Experimentation Duration of What if?.... Results treatment Time between treatments Waiting times and bottle necks No risk to patients through pilots Costs Resource utilisation Waiting times Operating Theatre, Emergency Department, Beds, Disease Pathways, Reconfiguration...
    17. 17. A simple simulation Patients come into a clinic for treatment They arrive every 5 minutes The treatment takes 10 minutes - What is the likely demand? How many clinicians do I need? What is my revenue/cost? How long are patients waiting?
    18. 18. A simple clinic – a typical week
    19. 19. Benefits of simulation Risk- Free Uses data intelligently More accurate than a spreadsheet Models variability Increases confidence in decision making Test and compares potential solutions Simulates the passing of time VisualEngages Stakeholders
    20. 20. Planning for Healthcare How long What is my What are is it How much How much demand my can I reasonable resource likely to expected spend? for patients have I got? be? outcomes? to wait? Financial Winners and Losers
    21. 21. Starting to simulate a new approach Patients at Risk Assessment of Need Exacerbation Services “consumed”
    22. 22. But…… • No real correlation between risk score and level of need Patients at Risk Assessment of Need
    23. 23. What the data is telling us
    24. 24. Over 30% of people over 75 years have multimorbidity Kent whole population data
    25. 25. Multimorbidity is more common than single morbidity Kent whole population data
    26. 26. The total health and social care cost is strongly related to multimorbidity Kent whole population data
    27. 27. The main contributors to total health & social care cost are acute nonelective admissions Kent whole population data
    28. 28. People with complex health & social care needs appear to demonstrate a ‘crisis curve’ Kent whole population data
    29. 29. More community, mental health and social care services are delivered to people following a ‘crisis’ than before the ‘crisis’ Kent whole population data
    30. 30. Some indications that an integrated care plan changes the pattern of services delivered to people BHR costing data
    31. 31. Implications • Evidence suggests that once people with complex care needs (multimorbidity) are identified, the services delivered to those people changes • If people with complex care needs could be identified before the „crisis curve‟, service changes could be put in place that may prevent some of the nonelective acute care Year of Care currency incentives • Providers to work together to deliver cost-effective care • Payment based on holistic outcomes not episodes of care LTC Year of Care programme encourages • Integrated care for a patient-centred and seamless patient pathway • Sharing of evidence to support service change (e.g. SIMUL8)
    32. 32. Current Simulation • Likelihood of patients accessing services by changing state of patients – Level of acuity – Increasing numbers of long term condition
    33. 33. How it works • Patients in each “state” have – A likelihood of accessing certain types of service (Acute, Community, Mental Health, Social Care), including accessing services more than once • Costs associated with those services
    34. 34. Results • Number of patients in each “state” by year • Costs by state per year • Comparison with locally determined tariff
    35. 35. Testing, testing… • Beta being tested with site data for year 2 • Comparing patients cared for by integrated care teams or not • Tested by sites for usability
    36. 36. What the simulation does… • Informs question development and data collection • Allows experimentation and hypothesis testing where no historic data available • Enables research evidence to be applied to policy and practice development • Shares national assumptions meaningfully at local level • Reduces risks in policy development by generating evidence for decisions
    37. 37. @NHSIQ enquiries@nhsiq.nhs.uk www.nhsiq.nhs.uk Improving health outcomes across England by providing improvement and change expertise
    38. 38. “Integration is a means to an end; the purpose is about better person centred care and better outcomes – it‟s about privileging, autonomy, prevention and wellbeing.” “It‟s about two organisations working together with the benefit for users of the services at the heart.” Available on NHS Improving Quality Stand

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