Carole Green Project Director. Mental Health PbR Developments 2003 SECTA Report Variation Complexity No link between intervention and outcome Poor data

Carole Green

Project Director

C PPPCare Pathways and Packages Project

Developing currencies for mental health payment by results



PPPCare Pathways and Packages Project








Mental Health PbR Developments • 2003 SECTA Report

• Variation

• Complexity

• No link between intervention and outcome

• Poor data

• Worth developing







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







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







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







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







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







InPAC • Clinical Decision Support Tool

• Standard Needs Assessment Tool

• Empirically derived care groups

• Standardised Care Plans

• Standardised aims of interventions

• Standardised activities







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?







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







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







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







Clinical Governance,

Q & O

Care Planning

Workforce Development

Service Planning/Redesign

Currencies for MH PbR

Access and Choice

QIPP

Local Models of Integration

Service Line Management

Cost Improvement Programme

Commissioning







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







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).

DECISION TREE

(RELATIONSHIP OF CARE CLUSTERS TO EACH OTHER)

Working-aged Adults and Older People with Mental Health Problems

A

Non-Psychotic

B

Psychosis

C

Organic

a

Mild/

Moderate/

Severe

b

Very Severe

and complex

a

First Episode

b

Ongoing or

recurrent

c

Psychotic crisis

d

Very Severe engagement

a

Cognitive impairment

1 2 3 4 5 6 7 8 10 11 12 13 14 15 16 17 18 19 20 21

CPPP

PBR Development Process:

Currency

Local

National

National

Tariff

Local

Local

National

Step

1

2

3

Mental Health

Clustering Tool

21 Clusters

£

Resource utilisation

(Tariff)

Quality Indicator 1

Quality Indicator 2

Quality Indicator 3

Quality Indicator 4

Quality Indicators

Activ

ity(in

terv

entio

n)

1 32

Currency Model

Cluster Algorithm

Care Transition Protocols

Describing the elements of a currency

Currency representation

Cluster

Period start

Weighting

Period end

Duration

Complex ongoing cases

Currencies and care transition points

Period startPeriod end

Unscheduled ReviewPeriodic Review

Period endPeriod start

Cluster 8

Care Transition Points

Cluster 10

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 1

Calculate the Relative Value Unit

Stage 2

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

CPPP







Key Linkages

• IAPT, Forensic, CAMH’s, LD, Addictions

• Personalisation, QIPP

• Operating Framework, Standard contract, Reference costs, MH commissioning

• Incentives & Best Practice

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













Contact Details

www.cppconsortium.nhs.uk

Office: 01482 389123

Mobile: 07984 630079

Email: [email protected]

mailto:[email protected]

Documents

Carole Green Project Director. Mental Health PbR Developments 2003 SECTA Report Variation Complexity No link between intervention and outcome Poor data