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Health and Care innovation Expo 2014, Pop-up University S173 - Day 1 - 1545 - Innovation and outcome based commissioning, from both the Commissioner's and CSU perspective Dr Nicholas Hicks #Expo14NHS
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Innovation and Outcome Based Commissioning
A Commissioner Perspective
Dr Nicholas Hicks
Founder & Chief Executive, COBIC
March 2014
Outline Context Outcome based commissioning
catalyst for innovation what and where
Practical lessons Conclusions
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Context acknowledgment change desperately needed relatively few ‘big ideas’ years of
top down ‘grip’ but little transformation commissioners dominated by powerful providers
growing recognition of potential of OBC particularly value based commissioning / COBIC
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The commissioner’s role
“One thing I have always found is that you have got to start with the customer experience and work backwards to the technology.”
Steve Jobs 1955-2011
Step 1: The Commissioners Role
Agent of the public Turn taxpayers money into better health,
reduced inequalities and accessible high quality services
Best possible value (benefit / £) outcome frameworks fixed allocation
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Step 2: Existing tools don’t work Activity based commissioning has not worked
Expensive• Detail• Annual cycle
Time-consuming Ineffective
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Step 3: Revolution in provision is needed
Lots of talented, dedicated people Organised around trades not service users Fragmented Optimise for their bit of care Waste and voltage drop in quality
Over-use Underuse Misuse
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Factors associated with waste, poor quality and poor outcomes
Misaligned incentives Ignoring public values and user preferences Poorly coordinated service provision Poor use of data and evidence Lack of constructive clinical engagement
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Elements of integrated care
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Step 4: It’s up to commissioners! Providers unlikely to start the revolution
themselves (even when they want to) Commissioners need to be the catalyst
Unlock provider innovation Create the environment for change Harness the forces of change
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Step 5: Commitment
Personal and organisational decision Not to leave it to someone else Not to follow the herd if heading further into the mire To have the courage to act but be….
• Responsible• Determined• Practical and intelligent• Decisive• Act at pace• Act at scale
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Outcome Based Contracts Multiple examples of pay for performance
Quality and outcome frameworks CQUIN (if outcomes included) COBIC
• Accountable Lead Provider / Prime Contractor• Alliance contract• Year of care (if outcomes included)
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Step 6: COBIC incentivises both outcomes and efficiency…
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The key elements
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Alliance v Prime Contractor / Accountable Lead Provider
Alliance Prime Contactor / Accountable Lead Provider
Shared Goal ✓ ✓
Common Outcomes ✓ ✓
Shared risks along delivery chain
✓(negotiated with commissioner)
✓(negotiated with providers)
Explicit integrator ✗ ✓
Single ‘go-to’ accountability
✗ ✓
Provider partner of equal power/say
✓ ✗
Sub-contracting ✗ ✓
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Everything changes : definition of purpose - outcomes that matter to service users incentives - better outcomes, better efficiency distribution of risk - locate where best managed distribution of power - increase for public & service user relationships - critical for success
between providers along the value chain between commissioner and provider between commissioners between clinicians and employing organisations between service users and ‘the system’ between independent and public sector
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COBICs in action
Lead Commissioners Cambridge and Peterborough
CCG Bedfordshire CCG Milton Keynes CCG Oxfordshire CCG Bexley CCG Croydon CCG Herefordshire CCG Sheffield CCG Staffordshire CCGs Sheffield CCG
Service Areas Older people Mental health, Maternity Continuing Healthcare Cardiac Urgent Care MSK Cancer Elderly Care
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Provider Response (1) spectrum of support and resistance acute sector has done well under PB’R’ mixed belief in ‘burning platform’ many providers see potential in
relative autonomy contract duration benefiting from reducing waste & improving
outcomes re-connect with staff values & unlocking professional
energy
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Provider Reaction (2) Most organisations start by seeing themselves as forming
kernel of lead provider / ACO / ICO New multi-party conversations between providers Active consideration of role
service provider v integrator +/- service provision Developing a response – e.g. costing care, identifying waste,
defining, mitigating and sharing risk Nervous / excited by
Scale Risk and opportunity
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Conclusions COBIC
has potential to be transformational is a social as well as technical process can be contracted and procured in various ways
Difficult but do-able Constructive providers develop innovative responses,
often in new partnerships Beware conflation of privatisation with OBC Share risk gradually and intelligently
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e-mail : [email protected]
Website: www.cobic.co.uk
Twitter: @COBICUK
Thank you.
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