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Carole Green Project Director

Carole Green Project Director . 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

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Carole Green Project Director

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  1. Carole Green Project Director

  2. Mental Health PbR Developments • 2003 SECTA Report • Variation • Complexity • No link between intervention and outcome • Poor data • Worth developing

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. InPAC • Clinical Decision Support Tool • Standard Needs Assessment Tool • Empirically derived care groups • Standardised Care Plans • Standardised aims of interventions • Standardised activities

  9. 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?

  10. 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

  11. 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

  12. 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

  13. Local Models of Integration Care Planning Cost Improvement Programme QIPP Access and Choice Clinical Governance, Q & O Currencies for MH PbR Commissioning Workforce Development Service Line Management Service Planning/Redesign

  14. 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

  15. 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).

  16. C P P P DECISION TREE (RELATIONSHIP OF CARE CLUSTERS TO EACH OTHER) Working-aged Adults and Older People with Mental Health Problems C Organic A Non-Psychotic B Psychosis 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

  17. Currency Local National National Tariff Local Local National PBR Development Process: Step 1 2 3

  18. Describing the elements of a currency

  19. Complex ongoing cases

  20. 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)

  21. Stage 2 Stage 3 Stage 1 Stage 4 Calculate Determine Calculate the Relative Model options weighted period cost per Value Unit For draft tariff durations day Staged costing process

  22. Quality & Outcomes National approach Outcomes and indicators cluster specific Pragmatic and developmental Replace CQUIN, link with current agendas Service user, clinical, performance C P P P

  23. Key Linkages • IAPT, Forensic, CAMH’s, LD, Addictions • Personalisation, QIPP • Operating Framework, Standard contract, • Reference costs, MH commissioning • Incentives & Best Practice

  24. 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

  25. Contact Details www.cppconsortium.nhs.uk Office: 01482 389123 Mobile: 07984 630079 Email: carole.green@humber.nhs.uk

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