London Mental Health Payments and Outcomes Overview 17/18
National Policy and Guidance Context Five Year Forward View Reform payment and incentives to move away from unaccountable block contracts. It recommends national and local outcomes measures should be used as part of the payment system. Delivering the FYFV for Mental Health: Developing Quality and Outcome Measures Local footprints to develop a suite of quality and outcome measures, to help build foundations to support outcomes-based payment for mental health Framework approach is proposed that will need to ensure the suite of quality and outcome measures developed reflects objectives and views of key stakeholders and ensure that they are; Clinically Relevant Reflect what people who use services (and carers) want Culturally appropriate and reliable Align with system-wide objectives Measurable using metrics with reliability and validity 2
What is the Payment and Outcomes? The London Mental Health Payment and Outcomes is a London wide programme supporting value transparency through payment reform and utility of outcomes in Mental Health. This programme is part of the London Mental Health Transformation which is hosted by Healthy London Partnership (HLP) and NHS England (London Region). The London Payments and Outcomes, is sponsored by a Trust Chief Executive (WLMHT) and a CCG Chief Officer (Kingston and Richmond CCG, SWL SRO) and provides leadership at a London level to ensure providers and commissioners have a collaborative approach to improving how mental health treatment is delivered and paid for. Some of the programme work streams for this financial year focus on the following; Clustering: Auditing of cluster variation and cost, Review of Cluster Practices in and around Crisis. Care Packages: Deep Dive Audit of Cluster 10, Develop SNOMED Map for London, review of London Reference Costs Outcomes: Agree a Single London PROM, Share best practice on the use of PROM, PREM and CROM. 3
Value in Healthcare The Porter Model Value = Health outcomes Cost The full set of outcomes that constitute the quality of care for the customer over the complete care cycle To reduce cost, the best approach might be to spend more on some services to reduce the need for others 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
Agreed P&O Work Priorities Clustering Care packages Outcomes Develop a pan London cluster training package to provide consistency on the use of clusters; and share best practice and resources for training Improve data quality and transparency by carrying out an audit of cluster variance and cost Understand unwarranted variation by providing a pan London deep dive audit into cluster 10 usage Facilitate learning from an audit of reference costs in order to improve transparency Shared learning from a Pan London SNOMED code map to support the implementation of SNOMED and consistency for benchmarking Develop a pan London use of outcome measures training package to support clinical teams with the implementation of outcomes based care Support consistent benchmarking and transparency of care by agreeing a single outcome measure to be collected at a London level Map the use of outcomes based care across London Share best practice on the use of CROMS, PREMS and PROMS Closing the health and well being gap and developing transparent payment mechanisms In the process of working up a proposal for a piece of modelling work: Taking a whole population approach Modelling what is the commercial and strategic viability of MH Trusts in moving to these new payment models especially as organisations move to being part of the alliance contract? Specifically how are Trusts and Commissioners supported to manage risk. Provider readiness framework What are the real tangible options supporting areas to produce their capacity/capability business angle What are the opportunities for mental health within a wider population based contracting system at a person level basis. (Utilising national and local reference costs) 5
Payment and Outcomes Deliverables Timeline Project overview 16/17 & 17/18 2016 2017 2018 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Supporting compliance with SNOMED Snomed Mapping Cluster training package Deep dive into cluster 10 Pan London SNOMED Code Map Initial use of Outcomes Workshop including initial results of sharing PROM Audit and Mapping of cluster variance Review of Reference Cost Data Outcomes mapping Use of Outcome Measures Training Package Single PROM for London Proposal Delivery of Use of Outcome Measures Training Package Activity / Deliverable Partnership Board Meeting Payments, Outcomes and Care Packages group meetings 6
London Mental Health Payment and Outcomes Governance London Mental Health Transformation Board London Mental Health STP Delivery Group London Payment and Outcomes Partnership Board National Steering Group Payment and Outcomes Group (Chair: Tim Kendell) London Mental Health Dash Board Clinical Group Technical Group London CFO Leads Meeting Payment and Outcomes Partnership Board dates: Strategic Board Chairs: Carolyn Regan (CEO, WLMHT) Tonia Michaelides (Managing Director, Richmond and Kingston CCG, SRO Mental Health SWL STP) Membership : CFO CCG Lambeth CCG DOF Trust CNWL Representation from NHS I / NHS E National Policy Clinical Representation (from various trusts) Commissioning Representation Quality Representation Payment and Outcomes Technical and Clinical Group: Technical and Operational Group Chairs: Debbie Taylor (Technical Chair, NELFT) Dr. Niraj Arora (Clinical Chair, WLMHT) Dr. Justin Earl (Clinical Chair, SWSTG) Membership: Clinical Reps from various Mental Health Trusts Technical Leads from various Mental Health Trusts Finance Leads from various Mental Health Trusts Commissioning Representation
Proposed Structure Payment and Outcomes Sponsor MH Trust: Carolyn Regan (WLMHT CEO) CCG: Tonia Michaelides (Kingston CCG CEO) Team PMO: Darren Vella Management Mental Health Clinical Network NHS England & HLP PMO Support: Carly Monaghan, Project Support Officer Network Chairs: Carolyn Regan (WLMHT CEO), Tonia Michaelides (Kingston CCG CEO) London Payments and Outcomes Partnership Board (Meet Bi-Monthly) Chair: Debbie Taylor (Technical Chair ELFT), Justin Early (Clinical Chair, SWSTLG), Niraj Arora, Clinical Chair, WLMHT) London Payment and Outcomes Clinical and Care Packages Technical Group Partners NHS Improvement, NHS England (National Team) 8
Payment and Outcomes Proposed Operating Model Matrix working approach where different deliverables are co-produced by system experts and leaders across different MH Trust / CCG organisations to create system ownership and understanding. Delivery Area Undertake a pan London deep dive audit into Cluster 10 Co-Production Matrix ü Technical Lead on Clustering ü Clinical Lead from Cluster 10 Services ü Commissioning Finance Input from CCG / Trust ü PMO System Inputs ü Participate in data-capturing exercises ü Shape methodology used ü System Ownership of Outputs Delivery of Pan London Deep Dive Audit into Cluster 10 9
London Mental Health Governance London CCGs Sustainability and Transformation Executive NHS England (London) London Transformation Group London Mental health Clinical Network NHS England (London Region) London Mental Health Transformation Board London Mental Health Parity Board NHS England (London Region) London Mental Health Transformation Crisis care Primary Care MH SMI Mortality Gap Hardwiring MH Access Standards London Thrive (Prevention) Coordination function New Models of Care CCG MH Clinical Leads Stolen Years Project SPG MH Chief Officers Commissioning Group First Intervention Psychosis London Perinatal Networks Stigma CYP Suicide U&EC Mental health sub-group Mental health partnership board Physical Health and Mental Health Leads London Payment and Outcomes Board Clinical Group Technical Group London Mental Health Dash Board FIP Work Force Project FIP Standard (2/2) Implementation Support IAPT Clinical Leads Employment (IPS) Digital Mental Wellbeing DMW Agile Team STP MH Leads Group
Alignment Specific Policy Direction and Implementation NHS England (National Team) Development of specific and detailed finance tools and guidance NHS Improvement P&O London Mental Health Transformation Identifying Once for London Opportunities for London and Regional delivery platform 11