Focus on population health, prevention and outcomes
As the NHS implements its 10-Year Health Plan, a fundamental transformation is underway in how care is commissioned and delivered. Integrated care boards (ICBs) are evolving into strategic commissioners, with a renewed focus on population health, prevention, and value-based outcomes. To realise this vision of strategic commissioning, commissioners, providers and others will need to understand how they can navigate this change.
PCC has supported commissioners by providing a programme of support throughout September by running three events focusing on outcomes-based commissioning, population health management and working together for neighbourhood success. As part of this programme a leadership course is being run in October and November which aims to help leaders feel more confident and better equipped to lead through the challenges ahead.
Our first event looked at commissioning for outcomes and values, led by Robert McGough a partner at Hill Dickinson LLP. To achieve the aims of the 10-year plan, commissioners need to refocus their attention to outcome-based commissioning which includes value-based healthcare, where the value can be described as a formula where value = health outcomes that matter to patients/cost of delivering healthcare. It is important to understand that value does not equate to the lowest financial cost.
To deliver on outcomes-based commissioning the enablers need to be place. Developing collaborative and partnership working relationships, using data to provide relevant insights with the supporting structures in place, such as procurements and contracts will be key to successfully delivering the aims of the plan.
With the move towards delivering care at a neighbourhood level, new delivery models will be required where form should follow function. When developing contracting models, key factors need to be considered such as duration, risk, defining outcomes and data for effective outcomes measurements. The session looked at prospective models that could be used as well as sharing case studies.
Our second event, led by Dr Steve Laitner, a GP and public health consultant, focused on the crucial area of population health management. Critical to ensure that commissioning plans are truly strategic is undertaking population health management. When we think of population health, we think of this as the health of an entire population with the aims of reducing health inequalities whilst improving physical and mental wellbeing of the population.
Population health management has the same aim but looks to achieve this through data driven planning to deliver people-centred, proactive care to optimise health outcomes.
This is done by using data to identify and support cohorts of patients with similar needs and planning and commissioning targeted and tailored interventions. We explored the method of segmentation to group individuals into their cohorts, using relevant variables such as frailty or the utilisation of health-care services. From segmentation we move on to risk stratification where we use data to predict the probability of adverse events and create a risk score. From risk stratification we move onto impactability, how likely is it that a patient is going to respond/be affected by a proactive targeted intervention. Real world examples were explored in the session.
Our third course, led by Safaa Jelassi, PCC adviser, explored the practical implications of the 10 Year Plan with a view to equip commissioners to develop skills, workstreams and tasks to enable them to commission integrated neighbourhood health services. Although operational guidance is still pending, the session covered realistic first steps to take.
ICBs will need to have in place a team that understands how community, mental health, acute as well as primary care services are commissioned and managed to be able to fully integrate services. The session raised awareness of the importance of integrating all four primary care services of dental, medical, pharmaceutical and eye care into plans, as these are often lacking from the discussions of neighbourhood health.
Building on the first two sessions, we took the areas of outcome-based commissioning and how health and population data will be indispensable to identify the needs of local populations and how data and clinical input is used to develop service specifications and contract appropriately. Linked to this is the need to develop an audit of existing services and providers and how they interact with each other, in terms of services but also in terms of contractual matters.
We asked delegates to consider the importance of primary care networks (PCNs) as a starting point for neighbourhoods, how neighbourhoods should look and what actions need to be taken regarding sourcing and improving estates.
Our leadership programme looks to give the confidence by exploring the issues leading with certainty through uncertainty as new ways of working are introduced, embedding cultural change and how to feel empowered to lead, listen and innovate rather than look upwards for instruction.
Feedback from delegates included “It was a really helpful overview and in-depth discussion of all the changes that are needed as well as what strategic commissioning will mean in the future.” And “Really enjoyed it – it started to think through how the contracting and financial landscape combines with trust and relationships”
Developing your local vision and putting the concepts into practice with relevant stakeholders is the next step. Let us facilitate and provide expert input, including value-based commissioning and population health principles, to shape future health care in your area. Contact enquiries@pcc-cic.org.uk to find out more.