Payment By Results – A partnership perspective

1. Payment By Results –A partnership perspective Nic Adamson DAAT Partnership Manager

2. Introduction • This outlines Worcestershire’s approach to procuring an outcome focused treatment system. • It incorporates payment by results. The process was supported by RichardTamlyn from the Centre for Public Innovation.

3. Context • The service had never been subject to procurement • The system had several components, none of which worked effectively together • The system was very blocked, the Willy Wonka factory of treatment. • Planned discharges are low • Lack of emphasis upon PSI • System not resilient to change

4. The vision • An integrated drug and alcohol service • Recovery orientated model • For adults and young people • Outcome focused delivery • Focused on positive and sustainable behavioural change • Main outcome, sustained recovery • Including payment by results

5. Procurement exercise • Describe the key outcomes your service will achieve • Outline the key performance targets you will use to achieve these outcomes • Tell us how many people will engage with your service each year, and of these, how many will achieve proposed performance targets

6. Year oneAllocating the costs • Total budget = 4million • For year one 25% by results • For year two 30% by results • For year three 40% by results • Calculations made to divide the outcomes across domains, looking at activity and intensity. • Critical to get it right!

7. MILESTONE MANAGEMENT What are milestones and how do they help?

8. Recovery plan agreed & identified 1819 Demonstrate improvement against TOPs, (reduction in days of use, criminal activity and improvement in life quality 1364 1023 Achieve identified goals 329 Achieve drug free/occasional use Payment point: £1236.50 per outcome, up to a maximum payment of £327,672.50 Sustain substance free for 4 weeks & planned discharge 265 Tier 3, Adult Drugs Funnel Evidence: Halo, Case file Audit, TOP's data, skills consortium requirements Milestone 1 Milestone 2 Milestone 3 Milestone 4 Milestone 5 Performance Target: 265 people will achieve 4 weeks drug free and be planned discharged

9. Domains of outcomes • Young people – tier 2 and 3 funnels • Adult drugs – tier 2 funnel, tier 3 PSI and a prescribing funnel and needle exchange funnel • Adult alcohol – tier 2 and tier 3 funnels • Family services funnel

10. How will payment be managed?

11. What were the key considerations? • Payment by results – year one is a test year, clear that future years will vary • Lot of work to spread the risk across domains • Ensure that outcomes are not process driven • Ensuring outcomes are internally driven, rather than affected by extraneous factors such as housing availability • Ensuring accuracy of base line data and achievability of outcomes • Ensuring all parties are clear on what is required • Involving all staff

12. What do we hope to acheive? • Focused service delivery • Shift to outcome focused commissioning • Shift to partnership commissioning • Value for money • A focus on behavioural change rather than treatment processes • Service issues highlighted early • Positive outcomes for service users • Transparency between provider and commissioner, supporting audit process • A service based on hope and strengths rather than problems and weaknesses

13. Lessons learned? • Still learning • Shared risk • Wait till year two to introduce fully • Allow for transformational change • Make sure outcomes are fair