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Our Experience of how English NHS bodies are using The Combined Predictive Model PRISM Learning Workshop 24th February 2

Our Experience of how English NHS bodies are using The Combined Predictive Model PRISM Learning Workshop 24th February 2010. Ian Manovel, Associate Director of Analytics 07826 557040 imanovel@healthdialog.com. Combined Predictive Model. Case Management. 0.5%. Disease Management. 4.5%.

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Our Experience of how English NHS bodies are using The Combined Predictive Model PRISM Learning Workshop 24th February 2

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  1. Our Experience of how English NHS bodies are using The Combined Predictive Model PRISM Learning Workshop 24th February 2010 Ian Manovel, Associate Director of Analytics 07826 557040 imanovel@healthdialog.com

  2. Combined Predictive Model Case Management 0.5% Disease Management 4.5% Supported Self Care 15% Prevention & Wellness Promotion 80% Combination of datasets = (IP, OP, A&E + GP) NHS

  3. Clinical Commissioning Analytics Model Integrated Care Manager Shared Decision Making Telehealth Virtual Wards Case Interventions Clinical & Analytic Lens Evaluation • Implementation • Demand & Supply • Focussed Interventions Commissioning Organisation • Intelligent • Commissioning • Data driven • Forward looking • Evidence-based • Locally informed • Integrated • ROI • PROMS • Randomised Controlled • Trial • Benchmarking • Vision • Objectives • Deliverables Service Design Commissioning OA Clinical Claims Mgt Benchmarking Root Cause Analysis Pathway Redesign

  4. Examples of three NHS bodies that deployed the Combined Predictive Model and tools West Midlands SHA Lambeth PCT West Kent PCT

  5. Gaps in care for Long Term Condition patients • Most NHS bodies target LTC patients due to high cost and QOF targets 5

  6. Diabetes gaps in care – PCT view • Improve care for diabetics by focusing on HbA1c

  7. Diabetes gaps in care – Practice based Commissioning • The cluster with the highest average risk score for diabetics has the lowest gap 7

  8. Medicines Management Practice variation in % of high risk patients prescribed 10 or more drugs per month. Polypharmacy associated with adverse health outcomes.

  9. Dementia Polypharmacy Increased risk of incorrect medicines usage and adverse health outcomes including emergency admissions. 9

  10. Average attendance per 1000 (98) “London Cosmopolitan Cluster” PCT benchmarking Variation in rate and cost of OP attendances compared to peers A cluster is a group of geographic areas (Supergroup) where the local populations have similar characteristics. This information is derived from census data used by the Office of National Statistics. 10

  11. Variation in OP attendances – Trauma & Orthopaedics PCT has very high variation in referral rates among practices

  12. Variation in OP attendances – Trauma & Orthopaedics Higher than expected rate and cost associated with greater than three attendances.

  13. Next year’s predicted cost analysis Top 5% highest risk patients this year are responsible for 32% of predicted year PbR costs and 49% of emergency admission costs

  14. N = 3,593 6.9 x Average N = 20,130 16% of patients N = 3,655 4.2 x Average N = 19,150 42% of next year’s cost or £40.3M 1.8 x Average 2.5 x Average N = 249,241 0.7 x Average Shared Decision Making Increased opportunity for intervention and impact

  15. Extended Definitions The extended diabetes definition Patients with a diagnosis of diabetes, complications of diabetes, procedures related to diabetes or on medication for diabetes using codes in GP (Read code) and Acute setting (ICD-10 codes) in IP data Including : • Those who currently take insulin or oral anti-diabetic medication • Those with diet controlled diabetes • Excluding : • Those with gestational or steroid-induced diabetes within the last 12 months • Those whose GP’s last Read code indicates diabetes resolved or diabetes excluded • Those on metformin alone without insulin or other anti-diabetic medications

  16. GP identified 11,253 Diabetes population 11,815 Analysis of PCT population (344,168) saw an increase of 575 patients 5% increase from the GP registry method currently used. = Extended definition 562 Extended Definitions The extended diabetes definition outcome

  17. Extended Definition: Current and Predicted Costs Increased opportunity for intervention and savings The extended definition of diabetes identifies additional patients who have a higher initial cost and have greater cost increases. We see £647 in additional total costs in the year after identification (36% increase). The cost in the year AFTER standard identification shows an increase of £234 per person in average annual costs (26% increase).

  18. A whole person approach to LTC management is critical: For the 3,180 diabetics at the end of Year 1, only 9% of admissions and 12% of costs in Year 2 were directly or indirectly related to diabetes

  19. Community Service Redesign ROI Top 5% high risk and very high risk segments predicted cost £40m Assuming a 20% reduction in acute services £8m budget for community service

  20. We still have a long way to go to design patient centered services that are cost effective and deliver the same quality of care but at least we have the evidence base to make informed decisions. Ian Manovel, Associate Director of Analytics 07826 557040 imanovel@healthdialog.com

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