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Payment by Results

Payment by Results. Dr Alex Horne Medical Director NELFT. The White Paper. Mandated PbR for Mental Health Go live April 2012. PbR Mechanism. Cluster all patients (eventually) using the outcome measure HONOS PbR (clustering tool)

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Payment by Results

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  1. Payment by Results • Dr Alex Horne • Medical Director NELFT

  2. The White Paper • Mandated PbR for Mental Health • Go live April 2012

  3. PbR Mechanism • Cluster all patients (eventually) using the outcome measure HONOS PbR (clustering tool) • Agree cost per intervention within each cluster at a local level

  4. Promises • To offer transparency on transactions • Patient level detail

  5. Contracts • From PCT block contract • Interim “cluster”/mental health commissioner and MOU • To CCG leads

  6. Service Delivery • NSF 2000-10 continued to drive the move from “asylums” • Estranged GP’s • Led to a “behind closed doors” perception for major stakeholders • MHS operated a kind of Wonderland

  7. Wonderland • Through NSF years • Contained • Managed symptoms and behaviour • Maintained • Post NSF must also achieve Enablement

  8. Strategic Challenges • Link PbR to • Choice + Personalisation • Reablement • Quality Agenda

  9. Challenges • Data Quality • Interpretation of Data • Robust mechanism for costing

  10. Progress in London • The London Currencies Development Board (LCDB) chaired by Wendy Wallace • London Health Programmes (LHP) • Commissioner Steering Group chaired by Stuart Saw • Programme approach • Engaged Stakeholders

  11. Risks • An unhelpful destabilisation of secondary mental health care • Vulnerable patients are not “contained” and appropriately managed

  12. Managing risk, complexity and integration Care Pathways System Management Multi-disciplined inter-agency teams • 2010s • Patient centred • Outcomes focused • Prevention and education • Personalisation • Increased Information Technology • Integrated Care Pathways Community Teams • 2000s • Single case records • Increased co-ordination and communications • Niche needs (AOT, EIT) • Individual care plans (inter-agency) • Alternatives to inpatient care (Crisis Houses, Recovery Centres, CRT) • 1990s • Individual teams • Limited facilities for inter agency and multi-profession working • Individual care plans – one size fits all Institutional Care

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