Launching an integratedcare organisation for NorthWest LondonIntegrated Care in London GP – Specialist collaboration      ...
There are five things we want to this afternoon               1 Overview of IC pilot and what we’re trying to             ...
OVERVIEW OF IC PILOTThe NWL integrated care pilot brings providers together to work acrossorganisational boundaries to imp...
3 The NWL integrated care pilot will remove barriers to enable the system     to implement whole system change across care...
Mission statement created by TIMB         1) Deliver high quality care for patients that makes an improvement in patient  ...
STRUCTURE AND GOVERNANCE OF IC PILOTGovernance modelIC pilot                                                              ...
STRUCTURE AND GOVERNANCE OF IC PILOTIntegrated Management Board                                           IMB Board       ...
Financial modelling suggests that £10m can be saved from emergencyadmissions; with a proportion split across the various p...
OVERVIEW OF IC PILOTLots of work to be done in the next few months – 7 working groups set up Workstream W k t           Wo...
We have already detailed and begun an intensive engagement strategy… Key dates   y                     January            ...
3 We have agreed the care pathways for frail elderly and diabetic patients  The clinical working group for the elderly ide...
MULTI-DISCIPLINARY SYSTEMSOur vision for a multi-disciplinary system – 7 core elements of the NWLmodel              Elemen...
OVERVIEW OF IC PILOTFollowing this phase of work; mechanisms will be in place to monitor andsupport the IC pilot within th...
Questions for discussion              1 How can we learn from you?              2 How should ‘organisational development b...
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Mark Spencer & Rebecca Rawesh: Launching an integrated care organisation in North West London

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Mark Spencer & Rebecca Rawesh: Launching an integrated care organisation in North West London

  1. 1. Launching an integratedcare organisation for NorthWest LondonIntegrated Care in London GP – Specialist collaboration London:and ‘Teams Without Walls’Wednesday 9th February 2011Dr Mark Spencer & Dr Rebecca Rawesh
  2. 2. There are five things we want to this afternoon 1 Overview of IC pilot and what we’re trying to achieve 2 Structure, governance and organisation design for the IC pilot 3 Fi Financial arrangements and implications of i l t d i li ti f the IC pilot 4 Clinical engagement strategy g g gy Integrating clinical relationships and creating 5 multi-disciplinary systems 1
  3. 3. OVERVIEW OF IC PILOTThe NWL integrated care pilot brings providers together to work acrossorganisational boundaries to improve care cost-effectively Why integrated care? Brent: 37,000▪ Current outcomes in C t t i Ealing: 25,000 patients care for the elderly and patients people with diabetes in NWL leave room for Westminster: improvement 122,000 , patients▪ Locally there is much enthusiasm for integrated working and improving collaboration Hounslow: Hammersmith and Kensington and across clinicians 33,000 patients Fulham: 101,000 Chelsea: 62,000 patients patients 1) Become a ‘beacon’ for delivering integrated care to the local population beaconWhat are involving primary, secondary, community, social and mental health sectorswe trying 2) Decrease emergency admissions by 30% and nursing home admissions bytoachieve 10% for diabetics and frail elderlyin NWL? 3) To overall reduce cost of these groups by 24% over 5 years 4) Significantly improve patient experience 2
  4. 4. 3 The NWL integrated care pilot will remove barriers to enable the system to implement whole system change across care pathways Overview Clinical changes Clinical enablers ▪ The 8 PCTs and providers in NWL face Aligned incentives Joint governance a £1bn funding gap by 2015 ▪ GPs from across 5 PCTs, Imperial College Healthcare, social services and central London Community Outcomes incentives will be aligned Representatives from each provider health have worked across providers, and providers will organisation will be part of a joint together to design a pilot Diabetes & the Elderly share a pool of funding governing, decision-making body that MDTs manage the health monitors and acts on issues ▪ This has been of a population, and supported by Kaiser specific programmes Information sharing I f ti h i Organisational development Permanente, Nuffield target patients based on and culture Trust, King’s Fund and need and risk McKinsey stratification and Co. ▪ The pilot will have major j clinical and financial Other Oth opportunities t iti benefits A group creates overall coordination across providers to improve A mechanism for sharing that Leaders and clinical teams spanning care and meet aggregates patient-level data so that it provider organisations will undertake commissioning intentions can be analysed and accessed in a joint training and development, and (e.g., (e g reduce LOS) timely, seamless way y y will begin to develop their own team g p culturesSOURCE: NWL Integrated care working team (Aug 2010) 3
  5. 5. Mission statement created by TIMB 1) Deliver high quality care for patients that makes an improvement in patient outcomes and satisfaction 2) Increase the level of trust, coordination and collaboration across clinicians with GPs, consultants and other providers working together towards better patient care 3) Become a ‘beacon’ for delivering integrated care to the local population 4) Create a vehicle for delivering productivity and efficiency improvements within and across the various providers 5) Improve the satisfaction of clinicians and healthcare workers across the sector through their ability to deliver proactive care 6) Make the IMB, as a representative group of providers, accountable for ensuring the successful and timely launch of the IC pilot 7) Ensure all providers are on-board and signed-up to pilot by g ) p g p p y giving ample g p opportunity to engage in the project and shape the IC 8) Ensure that all stakeholders are engaged including third sector, users of services and carers of those usersSOURCE: Interviews, Transitional IMB 4
  6. 6. STRUCTURE AND GOVERNANCE OF IC PILOTGovernance modelIC pilot LA Patients & PCTs ACV1 commis Public ▪ The IC pilot will establish new relationships between providers in NWL Mental ▪ These will be based on CLCH Imperial LA providers Third Sector Health contractual relationships rather than a new organisation ▪ The IC pilot will establish p GP practice mechanism for co- ordination and funding flows GP practice GP IC amongst providers leadership ▪ The Management Board (IMB) will agree resource GP practice IC plans, funds sharing, Pilot membership, etc GP practice ▪ Decision making will be by IMB consensus Providers LEGEND ▪ The IC pilot will include GPs, Imperial, CLCH, Local Authorities and Joint vehicles Mental Health trusts Commissioners ▪ GP practices elect leaders to represent primary care in the IC pilot. Providers ▪ Providers will pool a small amount of funds into the IC pilot to cover Funding flow F di fl Pooling of funds costs of more activity and mgmt1 Sector Acute Commissioning VehicleSOURCE: NWL Integrated care working team (Aug 2010) 5
  7. 7. STRUCTURE AND GOVERNANCE OF IC PILOTIntegrated Management Board IMB Board (Chair: Prof. Elisabeth Paice) Imperial (5 votes) GP Practices (11 votes) Central London Local Authorities (1 Third Sector (2 Mental Health (1 Community C it vote) t ) votes) t ) vote) t ) Healthcare (2 votes) Claire Holloway / Claire Perry, Brent: Dr Mandy Craig (James Reilly) Geoff Alltimes, Benn Peter Cubbon, Managing Director Chief Executive Chief Executive Keaveney, Chief Executive Officer Officer, London Lead, Age UK Officer Borough Tony Graff, Chief Hammersmith & Ealing: Dr Jennifer Durandt Jane Clegg, Finance Officer Fulham Roz Director of Rosenblatt, Operations Diabetes UK Josip Car, Clinical Programme Director, Marian Harrington, Hounslow: Dr Liz Morris PH Director of Adult Services, Westminster City Julian Redhead, Council Director of Medicine Hammersmith & Fulham: Dr Tim Spicer, Dr Simon Edwards and Dr Peter Jonathan Valabhji, Fermie Clinical Lead - Diabetes Kensington & Chelsea: Dr David Taube, Tahir, Dr Simon Ramsden Medical Director Edward Dickinson, , Westminster: Dr Ruth Clinical Lead - OHare, Peter Crutchfield, Elderly 1 TBC 6
  8. 8. Financial modelling suggests that £10m can be saved from emergencyadmissions; with a proportion split across the various providers Funding F di approach for integrated care pilot year (2011/12) hf i d il Funding fl F di flows (2011/12) £m (based on high-level analysis)2 Amount (£m) £m (based on high-level analysis)2 Incentive Payment Commissioners in NWL currently spend a 187 Additional Resource 1 disproportionate amount on diabetes and the elderly. £10*m comes out of acute Infrastructure Cost For a pilot of 380,000 the spend on these groups is care due to IC pilot QIPP Payment £187 ~£187 IC pilot providers agree the care pathways and targets 10* 2 for diabetes and the elderly and propose these to Commissioner 3.30 1.60 commissioners Commissioners reflect outcomes in provider SLAs and -6.7 2.10 3 Commissioner other contracts, expecting a decrease of activity they p g y y Balance provide in 2011/12 for the diabetes and elderly pilot1 population Does the IC pilot IC Joint Venture Commissioners keep the balance as part of its QIPP 3.3 deliver allocates 4 contribution improvements? funding The £6.7m that will be contributed by commissioners 5 via contracts (CQUIN and LES) is divided as follows: ▪ Additional out of hospital resource for more proactive -2.1 No Yes care (guaranteed payment) ▪ Infrastructure costs to run the pilot (guaranteed -1.6 payment) 3.00 3.00 ▪ Incentive payment for outcomes (dependent on 30 -3.0 achieving goals) Payment for If outcomes are not delivered by the IC pilot, the £3 acute over- 5 performance million of incentive funding will not be paid Any additional savings made by the IC p y g y pilot will be kept p Split of incentive payments and additional resource to be 6 by the providers recommended by finance group via detailed modeling1 Figures are calculated as a best estimate of the commissioning intentions specific to diabetes and elderly based on a pilot population of 380,0002 Analysis being further developed in current phase of work moving from top-down analysis to bottom-up modelling* Assumes actiivity removed at full PbR tariff from provider – in reality 30% marginal rate applies for activity reduction in 2011/12 7
  9. 9. OVERVIEW OF IC PILOTLots of work to be done in the next few months – 7 working groups set up Workstream W k t Working group W ki Responsibilities R ibiliti ▪ Design the new governance structure for sign-off by IMB including Governance roles, responsibilities, processes and various enablers required for Governance collaborating and Finance ▪ Discuss and problem-solve the various contractual and financial Finance implications of the IC pilot and how various providers will come together to deliver the change required Clinical Working ▪ Define clinical interventions for both Diabetes and Elderly Care (in Groups G separate groups) and set protocols and set core clinical agenda Clinical ▪ Define the ‘solution space’ for local MDT design (e.g., size, duration, MDT Mechanics frequency of interaction etc.) and develop a general toolkit to support local implementation ▪ Create and design an evaluation platform with metrics for the Evaluation patient experience, financial impact, clinical outcomes and change Evaluation and management to be used during the pilot and Research ▪ Identify various research opportunities within integrated care and Research discuss possible work and undertake research agreed upon within the group ▪ Form ‘technical design group’ to decide how to implement the Information required IT solutions and ‘functional design group’ to decide what the Information IT will need to look like Co-chairs (one GP and one Imperial Consultant) have been appointed for each working group 8
  10. 10. We have already detailed and begun an intensive engagement strategy… Key dates y January February March April Dates IMB 1 2 3 4 5 ▪ Page 26 Kick-Off ▪ 8th Feb MDT Support ▪ 1st Mar Forum (all 1 2 3 4 5 ▪ 23rd Mar Clinicians) ▪ 13th Apr ▪ 27th Apr GP Road-shows 1111 1 1 12 ▪ Various GP Practice-by- 2 ▪ Various Practice Visits One-on-one Interviews 1 1 11 1112 ▪ Various Imperial Fortnightly Imperial internal IC pilot meetings (when invited) Engagement <Best approach to be defined with Imperial > ▪ TBC Other Provider Engagement <Various mechanisms depending on provider> ▪ TBC 9
  11. 11. 3 We have agreed the care pathways for frail elderly and diabetic patients The clinical working group for the elderly identified priority areas The clinical working group for diabetes agreed roles and quality to improve care in the pilot elderly population through integration standards, and so the pilot will remove barriers to this Segments # of patients in pilot1 Segments # of patients in pilot1 In care 2,462 High needs 1,976 Support needed 3,337 3 337 Intermediate needs 3,969 3 969 Independent but at risk 2,850 Low needs 9,454 Independent and well 10,599 Newly diagnosed 1,106 Early identification of elderly Impact evidence Programme elements Impact evidence 1 frail people/risk stratification ▪ 30% reduction in bed Short term days Risk Case ▪ Higher % with BP stratification management under 140/80 and 2 Prevention programmes ▪ 20-80% reduction in (falls, medicine management) emergency admissions cholesterol under 4.5 Telemonitoring ▪ Improved HbA1c over time Diabetic & telephone Pro-active care planning and ▪ Reduction in registry support control (<7.5) 3 delivery by community team readmissions ▪ 100% uncontrolled and % ▪ 40-70% reduction in Improved Patient complex patients on education care plans Appropriate falls screening programmes 4 Longer term emergency responses ▪ Improved satisfaction ▪ 20-25% reductions in ▪ People getting the Multi-disciplinary Patient-held admissions Pro-active case management “right care” across team meetings records ▪ 40% Reduction in bed 5 of complex patients social and health days Clinical ▪ 80% Reduction in Care planning 6 Improved information flows education amputations Both pathways are based on individually case managing patients through p y y g gp g pathway-based MDTs and applying a risk-stratified set of interventions based on individual needs1 Pilot population estimated to be 380,000SOURCE: NWL Integrated care working team (Aug 2010) 10
  12. 12. MULTI-DISCIPLINARY SYSTEMSOur vision for a multi-disciplinary system – 7 core elements of the NWLmodel Element Description 1  List of covered population and associated data Patient from all setting of care registry 2  Segmentation of individual patients by risk Risk stratification 3 Clinical  Development of clinical protocols and care protocols and packages (including activity and resource care packages requirements) for each risk group 4  Creation of individual care plans in one-to-one Care plans meetings between clinicians and patients 5  Delivery of care plans by multiple professional Care delivery groups 6  Discussion of management of most complex cases Case conference 7  Review by MDS of patient experience, clinical y p p , Performance P f   outcomes, financial performance and team review effectiveness SOURCE: Team analysis 11
  13. 13. OVERVIEW OF IC PILOTFollowing this phase of work; mechanisms will be in place to monitor andsupport the IC pilot within the first year Post-Pilot Pilot Pre-Pilot ▪ Start of Dec 2010 to end of ▪ End of April 2011 to end of ▪ End of April 2012 onwards Timeline April 2011 April 2012 ▪ Develop work-streams and ▪ Provide on-going support to ▪ Agree ongoing resourcing Focus of work enablers to IC pilot through MDTs across sector that and funding based on various working groups have been formed decision to continue pilot or ▪ Ensure milestones are ▪ Continue roll-out of more not reached, through practices and MDTs across ▪ Monitor progress through transitional IMB, and the sector (and/or sign-up evaluation platform and decisions made on-time for more) performance management launch ▪ Monitor progress through processes ▪ Support and coordinate evaluation platform and ▪ TBD (based on success of ramp-up across NWL to performance management pilot): Introduce new form MDTs processes pathways and expand scope or partners of pilot Enabler to ▪ Clinical Engagement ▪ Clinical Engagement ▪ Clinical Engagement success ▪ Rapid input and work from ▪ Identification of early ▪ Output from research group working groups success metrics on new opportunities 12
  14. 14. Questions for discussion 1 How can we learn from you? 2 How should ‘organisational development be organisational development’ handled during the IC pilot? What financial arrangements need to work 3 for f success? ? 4 How can we get clinicians to work together more collaboratively? y 13

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