Developing an Outcomes Based Approach Stockport Together … · 2019. 5. 13. · 25 May 2017...

@obh_uk25May2017 ©OutcomesBasedHealthcare#GOLabHealthyLives

DevelopinganOutcomesBasedApproach

StockportTogetherCaseStudy

DevelopinganOutcomesBasedApproachStockportTogetherCaseStudyEllieBraganTurnerwww.outcomesbasedhealthcare.com

@obh_uk25May2017


Anynewoutcomesbasedpaymentframeworkshould:

•  Besimple,unambiguousandunderstandable

•  Beginwithachievableperformancetargets,whichprogressivelybecomemorechallengingasconfidenceincreasesintheunderlyingmeasuresandtheirabilitytoimprove

•  BelimitedtoarelaDvelysmallnumberofoutcomeswhichmaEertothetargetpopulaDon

•  NotimposeexcessivemeasurementandreporDngburdenoncommissionersorproviders

•  NotrestrictproviderinnovaDoninsupporDngdeliveryofimprovedoutcomes

Source: Outcomes Based Healthcare. (2015). Structuring Outcomes Based Incentives - Contractual Options and Key Considerations.


Outcomesdevelopmentprocessoverview

Population segmentation

Selecting outcomes Data Outcome

specifications Measurement Next steps

Who? What? How?






Who? What? How?


PopulaDonsegmentaDon

6

Whole Population

Healthy Maternity and Child Health Acute Long Term

Conditions Disability Short Period

of Decline and Dying

Organ Failure Frailty and Dementia

LTCs, Disability and Organ Failure

End of Life

Frailty and Dementia

Healthy and Acute

- Maternal health - Infant health - Child health

- Acutely ill - Cancer - Circulatory - Epilepsy - Mental health - Musculoskeletal - Respiratory

- Physical disability - Learning disability

- End stages of life - Often cancer

- Currently predominantly healthy

- Neurological - Organ failure

- Dementia - Mild frailty - Moderate frailty - Severe frailty (eFrailty Index)

Source: OBH, adapted from the Bridges to Health model – Lynn J, Straube BM, Bell KM, Jencks SF, Kambic, RT. (2007). Using population segmentation to provide better health for all: the ‘bridges to health’ model. The Milbank Quarterly: 85(2): 185-208.






Who? What? How?


Typesofoutcomemeasures

NEW SLIDE


SelecDngoutcomes

9Source: Outcomes Based Healthcare. (2017). Population Health Management. Outcomes Based Data and Technology Solutions.


SelecDngoutcomes

10

Expert Reference Groups

Joint Strategic

Needs

Assessment

Healthy (whole population)

Maintain longevity

Prevent accidents, illness and developing long term conditions

Long Term Conditions, Disability and Organ Failure

Maintain longevity

Manage condition effectively

Limit progression of condition

Maintain autonomy

Have support for care-givers and appropriate rehabilitation services

Avoid exacerbations

Maintain existing functional ability

Frailty and/or Dementia

Maintain existing function

Maintain mobility

Being treated with dignity and respect

End of Life

Cope well with illness at the end of life

To ‘die well’ (advanced care planning, being treated with dignity, making a personal feel comfortable)


SelecDngoutcomes

Expert Reference Groups

Joint Strategic

Needs

Assessment

11Source: Kings Fund conference: Mainstreaming PACs and MCPs: sharing the learning, 21st March. Available from: https://www.kingsfund.org.uk/sites/files/kf/media/Dr%20Cath%20Briggs%20and%20Rupert%20Dunbar-Rees.pdf






Who? What? How?


DataopDons

Option 1 Outcomes Frameworks &

Audits (e.g. NHS Outcomes Framework)

Option 2 National Datasets e.g. SUS or HES (secondary

care)

Option 3 Local datasets (e.g. direct local provider and/or primary care

data)

Reporting Time Annual Monthly Monthly

Time to Access 1-2 years or more! At least 6 weeks At least 6 weeks

Flexibility of Reporting (e.g. by segment, frailty score)

+ ++ +++

Linking Available ✘ ✓ ✓ Data Quality/Accuracy + ++ +++

Set-up/ Development Time + ++ +++


OBHdataapproach


DataspecificaDonandlinkage

15

Primarycaredata

Hospitaldata

Socialcaredata

FrailtyLTCmanagementSmokingstatus

BMIPalliaDveCareRegister

GPpracDceAgeSex

NewregistraDonsMovingaway

Deaths

ICD-10(diagnoses)OPCS(procedure)

HRG(tariff)Specialty

GPpracDceHospitalAgeSex

Typeofcare(emergency,elecDveetc)

AdmissionsA&E

OutpaDentTransfersDeath

GPpracDceAgeSex

LocaDonofsupportTypeofsupport

PhysicaldisabilityLearningdisabilitySubstanceabuseMentalhealthEndofLifecare

ReferralServicestartandenddates

ClinicalInformaDon AdministraDveinformaDon Events



16

Example:YearsofLifeLostforPeoplewithSevereMentalIllness

Primarycaredata

Hospitaldata

Socialcaredata



GPpracDceAgeSex


Deaths





AdmissionsA&E


GPpracDceAgeSex




ICD-10formentalhealth

Age

Mentalhealthsupport

READcodeformentalhealth

In-hospitaldeaths

Out-of-hospitaldeaths



17

Example:DaysdisruptedbycareforpeoplewithLTC,disabilityand/ororganfailure

Primarycaredata

Hospitaldata

Socialcaredata



GPpracDceAgeSex


Deaths





AdmissionsA&E


GPpracDceAgeSex




Servicestartdate

Age

Physicaldisability

Dateof

registraDon

READcodesforotherLTCs

Daysdisrupted(admission,

A&E,outpaDent)






Who? What? How?


TechnicalspecificaDons

•  DescripDon

•  RaDonale

•  PopulaDonsegment

•  NumeratordescripDon

•  Numeratordatasource

•  DenominatordescripDon

•  Denominatordatasource

•  CalculaDon

•  Typeofmeasure

•  ObjecDve






Who? What? How?


Measurement


Measurement






Who? What? How?


Nextsteps

24

-  Setavailablebudget

-  Decideon:-  OutcomeweighDngs

-  Paymentbands-  Targetvalues

-  Monitorprogress

[email protected] @ebraganturnerwww.outcomesbasedhealthcare.com @obh_uk

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