Value Based Commissioning A method for integrating care

Value Based Commissioning: A method for integrating care in the management of serious mental illness George Howard, Mental Health Lead Healthy London Partnership © George Howard

The Journey

Mental Health and Integrated Care Integration is a vitally important aspect of the experience of health and social care for millions of people. It has perhaps the greatest relevance for the most vulnerable and those with the most complex and long‐term needs

Government Policy Feb 2011 Jan 2014 Feb 2014 Oct 2014 No health without mental health: A cross -governmental health strategy for people of all ages Closing the Gap: Priorities for essential change in mental health Mental Health Crisis Care Concordat: Improving outcomes for people experiencing mental health crisis Achieving Better Access to Mental Health Services by 2020 5

Five Year Forward View for Mental Health 280, 000 more people living with severe mental illness will have their physical health needs met by increasing early detection and expanding access to evidence-based physical care assessment and intervention. Simon Stevens: “Putting mental and physical health on an equal footing will require major improvements in 7 day mental health crisis care, a large increase in psychological treatments, and a more integrated approach to how services are delivered. That’s what today's taskforce report calls for, and it's what the NHS is now committed to pursuing. ” Experiences of mental health care: Three quarters of people with mental health problems receive no support at all. People with severe mental illness are at risk of dying 15 20 years earlier than other people. Suicide rates in England have increased steadily in recent years, peaking at 4, 882 deaths in 2014. In a crisis, only 14% of adults surveyed felt they were provided with the right response.

Psychosis – The Challenge

‘Value’ in Healthcare Value = To reduce cost, the best approach might be to spend more on some services to reduce the need for others Health outcomes Cost The full set of outcomes that constitute the quality of care for the customer over the complete care cycle Excellent care is frequently the lowest cost Refers to total costs of the full cycle of care for the customer’s medical condition, not the cost of individual services VALUE-BASED COMMISSIONING means changing how healthcare is organised, measured and reimbursed in order to improve the value of services The unit of analysis is the individual not the organisation

How we structured our work Cohort What populations have linked healthcare needs? What type of contracting approach do we use? Contracting How do we establish a population cohort cost? Financial model Outcomes Service delivery What outcomes do we want to measure? How? What will be different for our population? How will care be organised?

Identifying our priority outcomes THE ISLINGTON TEAM: Andy Murphy Clare Henderson Clarissa Murdoch Dan Windross David Davis Eula Harrison Helen Oyedepo Martin Charters Martin Kuper Mel Phillips Michelle Wheeler Nasrin Hafezparast Noel Ryle Sue Newton Suj Ahmed Tina Jegede

Integrated Practice Unit model

Model of provision

Contracts – key criteria for contract form Lead Provider No change Contract form Staged approach Immediate approach Model of provisio n Integrator Loose alliance

Provider Assurance Process Aim of the provider assurance process is to put the best interests of patients first STAGE TWO Preferred Lead Provider identification Activity No. of providers STAGE ONE Market Assessment 100 s Notice issued to register interest 6 Provider information event Gateway criteria issued Questionnair e issued to providers still in process STAGE THREE Lead Provider confirmation 2 2 Questionnair e responses reviewed Panel Presentation 1 Lead Provider confirmed

Background (Current Contract) VBC CURRENT CONTRACT OUTCOMES PROCESSES AND A ACTIVITY B C Core services in scope Patient Cohort • The diagram opposite illustrates the current contracting position for an incumbent provider • The red dotted line square represents the current annual contract for all provider services and activities (i. e. the main clinical services contract) • The VBC Programme has identified that the area shaded grey and called ‘A’ relates to the agreed core activity for the identified patient cohort, e. g. people with diabetes. This forms the VBC financial envelope. Part of this is then allocated to outcomes (green) • The areas shown as B and C represent the related (B) and unrelated (C) specialist care linked to the identified patient cohort, e. g. people with diabetes which does not form part of the proposed VBC financial envelope and contract • The blue area represents all other activities and services that the provider delivers Additional related specialist care Additional unrelated specialist care Care for people outside of identified cohort REST 11 of 46

Contracting approach Single Over-arching Contract All parties – Providers and Commissioners Services Contract Provider / Commissioner Outcomes VBC Services Contract Acute Provider • • Mental Health Provider Community Provider Social Care Provider The VBC element (grey area) will be removed from the main clinical services contract and will be contracted for via a separate standalone VBC contract The outcomes element (green area) will be removed from the main clinical services contract and will sit under the Single Overarching Contract (SOC) which is signed by all parties and held by the lead provider

What does a staged approach look like? Full Bundle Source: ‘Contracting for Outcomes’, OBH and Capsticks, 2014 Partial Bundle

Outcomes into contracts Identify priority outcomes Expert Reference Group (refines and ‘signs-off’) Identification of methods of measurement Identify method of capturing ‘new’ data Allocate weightings to outcomes Set thresholds for achievement

Contract Structure SOC (Psychosis Outcomes) Mo. U Contract (Other Services) Note: Alcohol & Drug Services for LBI & LBC will not be part of 2016/17 contract Contract (Psychosis Activity) 41 of 46

PAYMENT SYSTEMS MATTER PP QI Whittington C&IFT & LBI Royal Free Integrated Practice Unit £ 2016