This document provides an overview of commissioning for value in healthcare. It discusses highlighting unwarranted variation in quality, outcomes, activity and spend using tools like the NHS Atlas of Variation. It emphasizes empowering patients through shared decision making using decision aids. It also covers engaging clinicians and commissioners to shift from "rationing" to "rational commissioning" and using information and insights to drive action and sharing of best practices. The goal is to increase value by focusing on health outcomes relative to total costs.
the paradigm is changing; the dominant focus for the next decade at least will be value, or to be precise triple value
The Aim is triple value & greater equity
• Allocative value, determined by how the assets are distributed to different sub groups in the population
• Technical value, determined by how well resources are used for all the people in need in the population
• Personalised value, determined by how well the decisions relate to the values of each individual
If you want to see more please look at http://bettervaluehealthcare.weebly.com
Value Based Care is a framework that helps healthcare ecosystem collaborate to provide value to patient for entire care-cycle. It also enables providers to iterate by measuring outcome and cost to maximise value over time.
March 02, 2018
Value-based health care is one of the most pressing topics in health care finance and policy today. Value-based payment structures are widely touted as critical to controlling runaway health care costs, but are often difficult for health care entities to incorporate into their existing infrastructures. Because value-based health care initiatives have bipartisan support, it is likely that these programs will continue to play a major role in both the public and private health insurance systems. As such, there is a pressing need to evaluate the implementation of these initiatives thus far and to discuss the direction that American health care financing will take in the coming years.
To explore this important issue, the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School collaborated with Ropes & Gray LLP to host a one-day conference on value-based health care. This event brought together scholars, health law practitioners, and health care entities to evaluate the impact of value-based health care on the American health care system.
For more information, visit our website at: http://petrieflom.law.harvard.edu/events/details/will-value-based-care-save-the-health-care-system
The Observatory of Innovation in Healthcare Management in Catalonia is the instrument used by the Catalan health system to catalogue the efforts made by organisations in innovating in several spheres of management. See more information at http://oigs.gencat.cat
While the cost of living in an assisted living community is often a shock to perspective residents, it is important to understand the value proposition of any facility you are considering to fully appreciate what your money is paying for. At United Methodist Communities, our non-profit, faith based mission insures that the costs of your care, pay for your care, and not corporate profits. Visit https://umcommunities.org/
the paradigm is changing; the dominant focus for the next decade at least will be value, or to be precise triple value
The Aim is triple value & greater equity
• Allocative value, determined by how the assets are distributed to different sub groups in the population
• Technical value, determined by how well resources are used for all the people in need in the population
• Personalised value, determined by how well the decisions relate to the values of each individual
If you want to see more please look at http://bettervaluehealthcare.weebly.com
Value Based Care is a framework that helps healthcare ecosystem collaborate to provide value to patient for entire care-cycle. It also enables providers to iterate by measuring outcome and cost to maximise value over time.
March 02, 2018
Value-based health care is one of the most pressing topics in health care finance and policy today. Value-based payment structures are widely touted as critical to controlling runaway health care costs, but are often difficult for health care entities to incorporate into their existing infrastructures. Because value-based health care initiatives have bipartisan support, it is likely that these programs will continue to play a major role in both the public and private health insurance systems. As such, there is a pressing need to evaluate the implementation of these initiatives thus far and to discuss the direction that American health care financing will take in the coming years.
To explore this important issue, the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School collaborated with Ropes & Gray LLP to host a one-day conference on value-based health care. This event brought together scholars, health law practitioners, and health care entities to evaluate the impact of value-based health care on the American health care system.
For more information, visit our website at: http://petrieflom.law.harvard.edu/events/details/will-value-based-care-save-the-health-care-system
The Observatory of Innovation in Healthcare Management in Catalonia is the instrument used by the Catalan health system to catalogue the efforts made by organisations in innovating in several spheres of management. See more information at http://oigs.gencat.cat
While the cost of living in an assisted living community is often a shock to perspective residents, it is important to understand the value proposition of any facility you are considering to fully appreciate what your money is paying for. At United Methodist Communities, our non-profit, faith based mission insures that the costs of your care, pay for your care, and not corporate profits. Visit https://umcommunities.org/
[HOW TO] Create High Performance Emergency DepartmentsEmCare
EmCare’s latest White Paper on implementing a system-wide approach to providing emergency care. At Baylor Health Care System, the initiative has fostered the development of numerous approaches to managing the challenges faced by its emergency departments, including an innovative protocol to manage overcrowding at the system’s flagship facility.
March 02, 2018
Value-based health care is one of the most pressing topics in health care finance and policy today. Value-based payment structures are widely touted as critical to controlling runaway health care costs, but are often difficult for health care entities to incorporate into their existing infrastructures. Because value-based health care initiatives have bipartisan support, it is likely that these programs will continue to play a major role in both the public and private health insurance systems. As such, there is a pressing need to evaluate the implementation of these initiatives thus far and to discuss the direction that American health care financing will take in the coming years.
To explore this important issue, the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School collaborated with Ropes & Gray LLP to host a one-day conference on value-based health care. This event brought together scholars, health law practitioners, and health care entities to evaluate the impact of value-based health care on the American health care system.
For more information, visit our website at: http://petrieflom.law.harvard.edu/events/details/will-value-based-care-save-the-health-care-system
Diabetes And Accountable Care Organizations: A Value-Based Care StrategyNorth Texas CIN (TXCIN)
Studies project that 1 in 3 people will develop type 2 diabetes by 2050. With this information in mind, what is the strategy for ACOs for diabetes care? How do they plan to lower costs? We give you the answers here
Healthcare by Any Other Name - Centricity Business WhitepaperGE Healthcare - IT
Whether referred to as integrated healthcare or accountable care, the
current focus on new healthcare models is a reaction to long-standing
concerns around quality, cost, and efficiency. Many of these issues stem
from care delivery systems that have been:
• Directed more at episodic treatment than prevention and early intervention
• Fragmented rather than integrated and coordinated
• Focused on patient eligibility and billing rather than patient engagement
within and outside of the care setting
• Customized to the idiosyncrasies of individual facilities rather than
standardized across care sites
• Rewarded more for volume than for quality and cost outcomes
The resulting inefficiencies have made healthcare less effective, less safe,
and more costly than can be tolerated, particularly against the backdrop of
a challenging worldwide economy. The old dictum ‘if you provide healthcare,
they will pay’ no longer applies. Public payers, private payers, and regulatory
agencies are wielding both carrots and sticks to drive healthcare organizations
toward greater coordination, demonstrable quality, and measurable
cost control.
The consensus on what ails our health systems, as well as the availability
of new technologies, has led to the creation of new models of delivery,
such accountable care organizations and integrated health organizations.
By whatever name, these healthcare models are designed to promote
accountability and improve outcomes for the health of a defined population.
Managing Total Joint Replacement Bundled Payment Models: Keys to SuccessWellbe
Speaker: Andrew Duncan, Executive Director for Orthopaedics and Rehabilitation at University of Florida Health
This webinar will describe bundled payments and episode of care based patient management strategies. Attendees can learn to successfully manage total joint replacement bundled payment programs and what clinical service delivery strategies to use to be positioned for success. The importance of collecting and using data to understand costs for the episode of care and to negotiate will also be a focus.
About the Speaker:
Andrew Duncan has been a licensed physical therapist since 1991, when he graduated from the State University of New York at Buffalo with his Bachelor of Science in Physical Therapy. Upon completion of entry-level training, he worked as a physical therapist for two years and then completed his post professional Master’s degree in Human Movement Science and became certified in Athletic Training at the University of North Carolina at Chapel Hill. He then underwent board certification by the American Board of Physical Therapy Specialties and became a Sports Certified Specialist in 2002. While working as a manager at rehabilitation corporations and later at an academic health care center, he developed a passion for the business of health care and went on to complete his MBA from the Simon School of Business at the University of Rochester and has also earned his DPT from Boston University. Since 2012, Duncan serves as the Executive Director for Orthopaedics and Rehabilitation at the University of Florida College of Medicine, Co-Director of the UF Health Orthopaedic and Sports Medicine Institute, and also serves as the Executive Director for Rehabilitation and Radiology Services at UF Health Shands Hospitals. He holds an adjunct clinical lecturer appointment in the University of Florida Department of Physical Therapy providing instruction in the Patient and Families First and Professional Issues courses of the DPT curriculum.
How to commission for improving health outcomes: measuring quality along care...The King's Fund
This slide set is the second of two looking at how Clinical Commissioning Groups (CCGs) can make the best use of measurement to support them to commission for improved outcomes.
This set looks specifically at how commissioners can build up sets of measures along whole pathways of care.
Automated Post-Discharge Care: An Essential Tool to Reduce ReadmissionsPhytel
Readmissions are a major problem in U.S. healthcare. Nearly one in five Medicare patients that are discharged from the hospital returns there within 30 days, and between 50 percent and 75 percent of those readmissions are considered preventable. Medicare pays about $17 billion annually for 2.5 million rehospitalizations of its beneficiaries and other payers spend roughly the same amount every year for all readmissions of non-Medicare patients.
Performance and Reimbursement under MIPS for OrthopedicsWellbe
The 2015 MACRA legislation fundamentally changed the way in which providers are paid for their services. It also provides some relief from the “all or nothing” approach used by Meaningful Use.
This session, a review of the Final Rule published on Oct 14, 2016, conveys a practical approach to maximizing reimbursement under MIPS while reducing burden on clinical staff.
After this session, attendees will have a firm grasp of:
– the major components of the Quality Payment Program
– operational strategies for measure selection
– orthopedic-specific quality measures
About the Speaker:
karenclarkKaren R. Clark is chief information officer for OrthoTennessee, where she has worked since 1998. In that role, she serves on national committees for the Healthcare Information Management Systems Society (HIMSS.) A HIMSS Fellow and Certified Professional in Healthcare Information and Management Systems, her current HIMSS committee is the HIT User Experience, which focuses on clinician experience with health information technology.
She has spoken at the AAOE, AAOS and OrthoForum conferences on both information security and the 2015 MACRA legislation, specifically on the Merit Based Incentive Payment System (MIPS.). She is a member of the College of Healthcare Information Management Executives (CHIME) as well as the CIO/CMIO Council with the American Medical Group Association.
After graduating from American University with a degree in marketing in 1979, she joined Brooks Brothers in New York, where she was a buyer. She earned her MBA in finance from Fordham University in 1984. She moved to Knoxville in 1988 and joined Watson’s as director of planning and distribution when her husband, Brooks, was recruited from Sports Illustrated to Whittle Communications. They have two adult daughters, Isabel, and Olivia.
[HOW TO] Create High Performance Emergency DepartmentsEmCare
EmCare’s latest White Paper on implementing a system-wide approach to providing emergency care. At Baylor Health Care System, the initiative has fostered the development of numerous approaches to managing the challenges faced by its emergency departments, including an innovative protocol to manage overcrowding at the system’s flagship facility.
March 02, 2018
Value-based health care is one of the most pressing topics in health care finance and policy today. Value-based payment structures are widely touted as critical to controlling runaway health care costs, but are often difficult for health care entities to incorporate into their existing infrastructures. Because value-based health care initiatives have bipartisan support, it is likely that these programs will continue to play a major role in both the public and private health insurance systems. As such, there is a pressing need to evaluate the implementation of these initiatives thus far and to discuss the direction that American health care financing will take in the coming years.
To explore this important issue, the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School collaborated with Ropes & Gray LLP to host a one-day conference on value-based health care. This event brought together scholars, health law practitioners, and health care entities to evaluate the impact of value-based health care on the American health care system.
For more information, visit our website at: http://petrieflom.law.harvard.edu/events/details/will-value-based-care-save-the-health-care-system
Diabetes And Accountable Care Organizations: A Value-Based Care StrategyNorth Texas CIN (TXCIN)
Studies project that 1 in 3 people will develop type 2 diabetes by 2050. With this information in mind, what is the strategy for ACOs for diabetes care? How do they plan to lower costs? We give you the answers here
Healthcare by Any Other Name - Centricity Business WhitepaperGE Healthcare - IT
Whether referred to as integrated healthcare or accountable care, the
current focus on new healthcare models is a reaction to long-standing
concerns around quality, cost, and efficiency. Many of these issues stem
from care delivery systems that have been:
• Directed more at episodic treatment than prevention and early intervention
• Fragmented rather than integrated and coordinated
• Focused on patient eligibility and billing rather than patient engagement
within and outside of the care setting
• Customized to the idiosyncrasies of individual facilities rather than
standardized across care sites
• Rewarded more for volume than for quality and cost outcomes
The resulting inefficiencies have made healthcare less effective, less safe,
and more costly than can be tolerated, particularly against the backdrop of
a challenging worldwide economy. The old dictum ‘if you provide healthcare,
they will pay’ no longer applies. Public payers, private payers, and regulatory
agencies are wielding both carrots and sticks to drive healthcare organizations
toward greater coordination, demonstrable quality, and measurable
cost control.
The consensus on what ails our health systems, as well as the availability
of new technologies, has led to the creation of new models of delivery,
such accountable care organizations and integrated health organizations.
By whatever name, these healthcare models are designed to promote
accountability and improve outcomes for the health of a defined population.
Managing Total Joint Replacement Bundled Payment Models: Keys to SuccessWellbe
Speaker: Andrew Duncan, Executive Director for Orthopaedics and Rehabilitation at University of Florida Health
This webinar will describe bundled payments and episode of care based patient management strategies. Attendees can learn to successfully manage total joint replacement bundled payment programs and what clinical service delivery strategies to use to be positioned for success. The importance of collecting and using data to understand costs for the episode of care and to negotiate will also be a focus.
About the Speaker:
Andrew Duncan has been a licensed physical therapist since 1991, when he graduated from the State University of New York at Buffalo with his Bachelor of Science in Physical Therapy. Upon completion of entry-level training, he worked as a physical therapist for two years and then completed his post professional Master’s degree in Human Movement Science and became certified in Athletic Training at the University of North Carolina at Chapel Hill. He then underwent board certification by the American Board of Physical Therapy Specialties and became a Sports Certified Specialist in 2002. While working as a manager at rehabilitation corporations and later at an academic health care center, he developed a passion for the business of health care and went on to complete his MBA from the Simon School of Business at the University of Rochester and has also earned his DPT from Boston University. Since 2012, Duncan serves as the Executive Director for Orthopaedics and Rehabilitation at the University of Florida College of Medicine, Co-Director of the UF Health Orthopaedic and Sports Medicine Institute, and also serves as the Executive Director for Rehabilitation and Radiology Services at UF Health Shands Hospitals. He holds an adjunct clinical lecturer appointment in the University of Florida Department of Physical Therapy providing instruction in the Patient and Families First and Professional Issues courses of the DPT curriculum.
How to commission for improving health outcomes: measuring quality along care...The King's Fund
This slide set is the second of two looking at how Clinical Commissioning Groups (CCGs) can make the best use of measurement to support them to commission for improved outcomes.
This set looks specifically at how commissioners can build up sets of measures along whole pathways of care.
Automated Post-Discharge Care: An Essential Tool to Reduce ReadmissionsPhytel
Readmissions are a major problem in U.S. healthcare. Nearly one in five Medicare patients that are discharged from the hospital returns there within 30 days, and between 50 percent and 75 percent of those readmissions are considered preventable. Medicare pays about $17 billion annually for 2.5 million rehospitalizations of its beneficiaries and other payers spend roughly the same amount every year for all readmissions of non-Medicare patients.
Performance and Reimbursement under MIPS for OrthopedicsWellbe
The 2015 MACRA legislation fundamentally changed the way in which providers are paid for their services. It also provides some relief from the “all or nothing” approach used by Meaningful Use.
This session, a review of the Final Rule published on Oct 14, 2016, conveys a practical approach to maximizing reimbursement under MIPS while reducing burden on clinical staff.
After this session, attendees will have a firm grasp of:
– the major components of the Quality Payment Program
– operational strategies for measure selection
– orthopedic-specific quality measures
About the Speaker:
karenclarkKaren R. Clark is chief information officer for OrthoTennessee, where she has worked since 1998. In that role, she serves on national committees for the Healthcare Information Management Systems Society (HIMSS.) A HIMSS Fellow and Certified Professional in Healthcare Information and Management Systems, her current HIMSS committee is the HIT User Experience, which focuses on clinician experience with health information technology.
She has spoken at the AAOE, AAOS and OrthoForum conferences on both information security and the 2015 MACRA legislation, specifically on the Merit Based Incentive Payment System (MIPS.). She is a member of the College of Healthcare Information Management Executives (CHIME) as well as the CIO/CMIO Council with the American Medical Group Association.
After graduating from American University with a degree in marketing in 1979, she joined Brooks Brothers in New York, where she was a buyer. She earned her MBA in finance from Fordham University in 1984. She moved to Knoxville in 1988 and joined Watson’s as director of planning and distribution when her husband, Brooks, was recruited from Sports Illustrated to Whittle Communications. They have two adult daughters, Isabel, and Olivia.
Professor Sue Hill OBE, Chief Scientific Officer for Englandrightcare
We are excited to introduce the NHS Atlas of Variation in Diagnostic Services, the latest publication in the series of impressive NHS Atlases, which have highlighted variation in the provision of healthcare services.
Diagnostic services are of great importance in the NHS because, when used correctly, they support or rule out potential diagnoses, and underpin the effective and efficient management of patient pathways.
Unwarranted variation in the rates of diagnostic testing is of the utmost relevance to individual patients with the over-use, as well as under-use, of diagnostic tests being potentially serious issues. For example, effective capacity planning in imaging services should enable improved patient access balanced against the need to avoid over-use of interventions that have the potential to cause harm, such as ionising radiation.
The need to understand variation in healthcare population healthcare online...rightcare
Variation in healthcare remains endemic, with many articles published in the past 40 years identifying the existence of variations in health care across demographic groups, geographic areas, institutions and even individual health care providers within a single institution and in hospital treatment rates.
There is also evidence of variations in general medical practice and between general practitioners (GPs) and practices, with variations identified in areas such as the frequency of contacts, registration of diagnoses, diagnostic test ordering, referrals, prescription rates, and return visits.
Mapping variations presents some clear directions of travel. For instance, if there is variation
in rates of admission to stroke units, it is obvious that the rate of admission needs to
increase in those populations in which the rate of admission is low. Unwarranted variations
offer health services in every country the opportunity to obtain greater value from
healthcare resources.
Right Care Atlas of Variation in Healthcare - Children and Young Peoplerightcare
For the first time, variations across the breadth of child health services provided by NHS England are presented together to allow clinicians, commissioners and service users to identify priority areas for improving outcome, quality and productivity.
This presentation is by Dr Ronny Cheung, Atlas editor and Paediatric SpR St Thomas' Hospital, London
Rethinking Value Based Healthcare
Around the world healthcare providers are busy exploring how value-based healthcare can both improve the efficiency and effectiveness of healthcare delivery and seed new opportunities for innovation. Continuing our collaboration with Denmark, we are very pleased to release a new perspective on how VBHC can have greater impact in practice. Based on insights from a recent event hosted by DTU Executive Business Education and undertaken in partnership with Rethink Value, this point of view looks at the key issues for patients, physicals, providers and payers.
It explores some of the associated implications for healthcare systems worldwide, highlights several leading early examples of VBHC in practice and looks at how it can have impact at scale. Recommendations focus on the structure of care, key metrics, moving beyond pilots, changes in reimbursement models and the need for greater insight sharing and deeper collaboration.
For related Future Agenda research see www.futureofpatientdata.org
EIT Health was established in 2015, as a ‘knowledge and innovation community’ (KIC) of the European Institute of Innovation and Technology (EIT). The EIT is made up of various KICs who each focus on a different sector, or area, of innovation – in our case, that is health and aging. The idea behind the EIT KICs is that innovation flourishes best when the right people are brought together to share expertise. The so called ‘knowledge triangle’, is the principle that when experts from business, research and education work together as one, an optimal environment for innovation is created.
https://eithealth.eu/
As the financial and demographic landscape changes, our healthcare services need to provide something significantly different to meet the needs of the Scottish population. In this session Gerry Marr talks about how do we make best use of the resources we have and what are we already doing that is transforming healthcare.
The article discusses how the Comprehensive Care Physicians (CCP) model proved to improve patient care and reduce utilization for patients at increased risk for hospitalization.
This monograph provides an assessment of the current hospital-physician landscape and outlines an innovative vehicle for advancing hospital-physician relationships that has the potential to improve care delivery and coordination, clinical quality, and patient cost. Our findings and recommendations address:• Changes in the market place.• The concept of an integrated medical staff model.• The role of operational clinical integration, enabled by an Electronic Medical• Record, toward creating virtual medical staffs.• Benefits to the hospital, physicians, patients and community.• What boards and senior management can do to move toward the model.
Better health outcomes at less cost - future nhs stage, 4pm, 2 september 2015NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
How to Engage Physicians in Best Practices to Respond to Healthcare Transform...PYA, P.C.
PYA Principal Kent Bottles, MD, spoke about physician engagement when it comes to value payment models during “How to Engage Physicians in Best Practices to Respond to Healthcare Transformation” at the Georgia Society of Certified Public Accountants’ (GSCPA) 2016 Healthcare Conference, February 11, 2016. Dr. Bottles discussed the difficulty of weaning physicians from fee-for-service payment models and the often-unappreciated reasoning behind the shift to value-based payment models. He also highlighted MACRA, MIPS, patient satisfaction surveys, Physician Compare, and the ProPublica Surgeon Scorecard.
mHealth Israel_Gil Bashe- NAVIGATING THE MAZE- US PROVIDER SYSTEMS HAVE MULT...Levi Shapiro
Presentation for mHealth Israel by Gil Bashe, Managing Partner, Finn Partners- Navigating the Maze- US Provider Systems Have Multiple Decision Makers.
- THE IMPORTANCE OF CLINICAL TRIALS AND HOSPITALS
- TO SUCCEED, YOU WILL NEED TO NAVIGATE THE COMPLEX HEALTH ECOSYSTEM
- UNDERSTAND DECISIONS AND TRANSACTIONS MADE
- THE MISSION SEEMS CLEAR – ENGAGE ONE MAJOR INSTITUTION
- REALITY – IT’S A COMPLEX MAZE WITH LAYERS OF DECISION MAKERS
- CLINICAL TRIALS AND DATA DEFINE THE WINDOW OF VALUE
- IT’S ONE BRAND, ONE LOCATION, AND A MYRIAD OF DECISION MAKERS
- CHAMPION CHECKLIST
Why Clinical Quality Should Drive Healthcare Business StrategyHealth Catalyst
Health systems feel mounting pressure to demonstrate ROI from analytics investments but are faced with inefficacies and delays. Fortunately, the Rapid Response Analytics Solution delivers a 10x increase in analytics productivity and a 90 percent decrease in the time required to develop new analytic insights. The Rapid Response Analytics Solution solves these tough analytics problems through two primary elements: curated, modular data kits called DOS Marts; and Population Builder, a powerful self-service tools that lets any time of user, from physician executive to frontline nurse, explore data and quality build cohorts of patients without relying on IT staff and with no need for sophisticated and customized SQL and data science coding.
R. binks healthcare policy long term conditions experiences of yorkshire
Right Care @ the NaPC Conference
1. Commissioning for Value
How Right Care can support CCGs to get value
for patents and populations
Professor David Colin-Thomé
Independent Health Care Consultant
Member of the Right Care team, Department of Health
www.dctconsultingltd.co.uk
david@dctconsultingltd.co.uk
Copyright 2011 Right Care
2. CHANGE; Both the bureaucracy and the
market have a part to play but what is
needed are complex adaptive systems
because healthcare is too complex to be
managed through the market or bureaucracy
alone
2
3. Liberating the NHS…or bamboozling?
“Design an approach to moderation, conditions and decisions that is
consistent, proportionate, transparent, and legally compliant,
supporting the delivery of an efficient and consistent decision-making
process. The process design will be accompanied by template
documents and conditions to further support efficiency and
consistency.
This rigorous approach will also protect both the NHS
Commissioning Board (NHS CB) and CCGs by ensuring that the
risks of CCGs taking on responsibilities before they are ready to do
so are minimised, whilst maximising the opportunities for full
authorisation.”
“One reason for the conditions will be that groups are required to
demonstrate strong and “credible” operational and service planning
for 2013-14, including how they will achieve financial balance. Few
CCGs are in a position to do so and no framework or guidance is yet
in place.”
3
4. A changing paradigm
20th Century Health 21st Century Health Care
Care
Patient-centred
Focus on prevention of disease &
Clinician-centred harm
Focus on benefits of treatment
Increase quality
Reduce waste and increase value
Patient as passive complier Patient as co-producer
Good care for known patients Equitable care for populations
Hospital as focus Focus on systems
Operates through bureaucracy Operates through networks
Driven by finance Driven by knowledge
High carbon usage Low carbon usage
Challenges met by growth
Challenges met by transformation
4
6. Right Care - Commissioning for Value
“Value in any field must be defined around the
customer, not the supplier. Value must also be
measured by outputs, not inputs. Hence it is
patient health results that matter, not the volume
of services delivered. But results are achieved at
some cost. Therefore, the proper objective is..
the patient health outcomes relative to the total
cost (inputs). Efficiency, then, is subsumed in the
concept of value. ”
Source: Porter ME. (2008) What is Value in Health Care? Harvard Business School.
Institute for Strategy and Competitiveness. White Paper.
6
8. Value = Outcomes / Costs
Outcome = Good – Bad
(Outcome= Effectiveness – Harm)
8
9. The Right Care Programme
Right Care is a programme designed to increase the
value from the resources allocated to healthcare
We do this by:
• Highlighting un-warranted variation in quality,
outcomes, activity and spend
• Empowering patients through shared decision making
• Engaging clinicians and commissioners to shift from
“rationing” to “rational commissioning”
• Using information to create insights leading to action
and ensuring these insights are shared
9
13. Variations in healthcare
Variations in healthcare exist for many legitimate
reasons. Populations and individuals have distinct needs,
and some of the variation observed is a reflection of the
responsiveness of the service to meeting particular
needs.
However, the degree of variation demonstrated for
instance in the Right Care Atlas of Variation cannot be
explained solely on that basis.
Unwarranted variations are driven not by the needs of the
patient but by the limitations of the healthcare system
and the healthcare professionals within it.
13
14. The NHS Atlas of Variation 2011
Reducing unwarranted variation to increase
value and improve quality
“A good map is worth a
thousand Words…
… cartographers say, and they are right:
because it produces a thousand words: it
raises doubts, ideas. It poses new questions,
and forces you to look for new answers.”
Franco Moretti (1998)
Atlas of the European Novel 1800–1900
14
15. Right Care Themed Atlas Series
Themed atlases focus on specific
conditions or populations in more depth
and are developed as collaborations with
key stakeholders
• Child and Maternal Health (Out now)
• Diabetes Care (Out now)
• Kidney Care (Out now)
• Respiratory Disease (Out now)
• Organ Donation and
Transplantation (Dec)
• Liver Disease (Dec)
• Diagnostics (Jan 2013)
…2013/14?
15
16. Examples of Variation in Child Care
Breastfeeding: There is a three-fold variation in breastfeeding rates
for babies aged 6-8 weeks across the country.
Asthma: Variation in the treatment of child asthma has got worse. In
2008/09, there was a four-fold variation in the rate of children
admitted for emergency hospital treatment – now, that has risen
to a five-fold variation.
Epilepsy: There is a four-fold variation in the emergency admission
rate for children with epilepsy.
A&E: There is a 3.5-fold variation in A&E attendance for children
aged 0-4.
Diabetes: There is a 2.6-fold variation in the percentage of children
with diabetes admitted to hospital for diabetic ketoacidosis – a
serious emergency condition that can lead to coma or even death
if Type 1 diabetes is not properly managed
16
17. www.rightcare.nhs.uk/atlas
In print
You can order free printed copies using
the online form on our website
Online
High and Low resolution PDFs are
available for download
Interactive
A fully interactive
InstantAtlastm is available
online
17
19. Patient Decision Aids –
empower patients, get better decisions
International evidence suggests a 20 per cent reduction
in „discretionary surgery‟ when Patient Decision Aids are
used (Cochrane Collaboration review)
Research from the Ottawa Hospital Research Institute
also states that patients who don‟t have decision support:
• Are 59 times more likely to change their mind
• Are 23 times more likely to delay their decision
• Are five times more likely to regret their decision
• Blame their practitioner for bad outcomes 19%
more often
19
20. Decision Aids reduce rates of discretionary
surgery
0% 25% 50% 75%
CA-Prostatectomy
CAOrchiectomy*
coronary bypass*
coronary bypass
hysterectomy
.
hysterectomy*
mastectomy
back surgery Standard Care
mastectomy* D-Aid
bphprostatectomy
bphprostatectomy
O‟Connor et al., Cochrane Library, 2009
RR=0.76 (0.6, 0.9)
20
21. Engaging with clinicians and
commissioners to shift from
“rationing” to
“rational commissioning”
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22. “Dis-investment” to fund innovation?
There has been controversy surrounding “rationing” in the NHS, with
PCTs challenging the use of a range of interventions, sometimes
deemed to be of “low value”, and developing clinical policies to
reduce the level of interventions,
Right Care supports the shift from lower to higher value interventions
to provide the “innovation fund” – achieving consensus around that is
however difficult.
Right Care is working with the Royal College of Surgeons and the
Federation of Specialist Surgical Associations to develop
Commissioning Guidance. Surgical Commissioning Guidance will
support CCG‟s to commission evidence-based, cost effective care for
patients with conditions amenable to surgical intervention
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23. We will do this by…
• the description of evidence based high value care
pathways
• highlighting variation in the provision of surgical services
• describing process and outcome measures that allow
commissioners to make intelligent commissioning
decisions
• providing levers for change within the local healthcare
community
• links to patient and clinician facing information, and
practical examples of high value care pathways that have
been implemented in other healthcare communities
• identifying priority areas for research
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24. Procedures Explorer
To support the development work
for guidance production, Right
Care has commissioned East
Midlands Quality Observatory to
develop a Procedures Explorer
Tool and populated it with national
SUS data. The tool can be used:
• By commissioners to
understand how commissioning
actions can influence variation The PET will be available online in
in spend and outcomes at a early 2013.
granular level
• By providers to understand how
their behaviour can influence
outcomes, which may be
different from those of other
providers across the country
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25. Using information to create
insights, leading to action and
ensuring these insights are
shared
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26. NHS Right Care have previously produced “Health Investment Packs” for each of
the 151 Primary Care Trusts in England. The packs used available health
investment tools to highlight areas where outcome was poor compared with
spend, and with other similar PCTs.
http://www.rightcare.nhs.uk/index.php/tools-resources/health-investment-packs/
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27. Information Available for Commissioners
The products available to commissioners including:
• Programme Budgeting Spreadsheet;
• SPOT (Spend & Outcome Tool);
• Programme Budgeting Atlas;
• NHS Comparators.
• Inpatient Variation Expenditure Tool (IVET)
These tools allow commissioners to compare expenditure and outcomes at
disease level.
To access these tools visit;
www.networks.nhs.uk/nhs-networks/health-investment-network/key-tools
These tools are a starting point for the process of making health investment
decisions.
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28. NHS Comparators
NHS Comparators provided by the IC on the NHS net;
nww.nhscomparators.nhs.uk
Holds data at England, SHA, PCT and Practice level;
Data are timely and frequent – every quarter up to Q3 2009/10
Various sources of data including:
total admissions – activity and expenditure;
non-elective admissions – activity and expenditure
elective admissions – activity and expenditure
prescribing – items and expenditure
better care better value metrics – including low cost statin prescribing
Very powerful for showing variation, and time series – which allows to track
change over time
Outpatient referrals by GP
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32. Example SPOT chart – NHS Nottingham City spends more per head on cancer and has a higher
premature mortality rate than similar areas.
Mortality
from all
cancers,
under 75
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33. NHS Oldham
….uses Programme Budgeting Tools to show
that, when compared to similar PCTs, NHS
Oldham has;
• Above average overall spend for Musculo
Skeletal system problems (MSK) and higher
proportion spent on elective admissions
• Lower health gain for patients receiving hip
replacements than patients in PCTs with similar
pre-op health status. Patients have relatively
low pre-op health status compared to PCTs with
similar deprivation levels
• Average health gain for patients receiving knee replacements compared to
patients in PCTs with similar pre-op health status. Patients have relatively
higher pre-op status compared to PCTs with similar deprivation levels
• High FHS prescription rate for MSK
• Low GP referrals to T&O but high referrals from A&E, MIU & Walk in
Centres and average overall T&O outpatient attendances
• High rate of elective admissions for MSK and long length of stay
• Low rate of emergency admissions for MSK but long length of stay
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34. NHS Western Cheshire
The result is that demand for acute services is starting to
fall. £7m of the re-investment were delivered in just 6
months.
Western Cheshire took a three stage approach to this
work:
• Understanding their current expenditure to identify areas to
target
• Service reviews of identified areas /health programmes
• Implementation of the agreed recommendations from
service reviews
Service reviews identified a range of changes specific to each service, including:
• Service redesign to change a pathway from current to best practice.
• Contract management or procurement change to get a service provided to a higher
quality and/ or lower cost.
• Decommissioning of a service/pathway because it does not add value or delivers more
capacity than is necessary.
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35. Derby city and Derbyshire county CCGs
Working locally in Derbyshire, Right Care has
facilitated the development of 7
“Commissioning for Value Information packs”
– soon to be 11, covering Derby city and
Derbyshire county CCGs.
The packs have been produced with local
engagement of CCGs and use both national
and local data analysis to generate
recommendations for action in 4 programme
budget areas.
As the Erewash Casebook shows – this has
lead to changes in pathways/systems and real
cash savings for re-investment
Get all these Casebook online at
http://www.rightcare.nhs.uk/index.php/tools-resources/
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36. Next Steps
Visit the Health Investment Network website:
www.networks.nhs.uk/nhs-networks/health-investment-network
Use the E guides to understand how the tools use in this slidepack work and to
gain a better understanding of expenditure and associated outputs and
outcomes.
Produce versions of this slidepack for other programme budgeting categories.
Download the annual population value review which provides a contextual guide
to the health investment process.
Access a video learning module that explores the definitions, tools and practical
application of Programme Budgeting Marginal Analysis (PBMA)
Find Useful links to other tools, data sources, reports and guidance.
Further information regarding QIPP Right Care can be found at:
www.rightcare.nhs.uk
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37. Follow Right Care online
- Subscribe to get a weekly digest of our blog in your inbox
- Receive Occasional eBulletins
- Follow us on Twitter @qipprightcare
www.rightcare.nhs.uk
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