Relieving distress, transforming lives IAPT Payment by Results Project Update David Perton IAPT PbR Project Manager Department of Health

Relieving distress, transforming lives What the Presentation will Cover The Currency Model The Data Being Collected The Analysis Reporting Timescales The Project Plan The Analysis to be Undertaken What is Outside the Scope of the Feasibility Study

Relieving distress, transforming lives The Draft Outcomes Based Currency Model The five outcome areas are: 1. Equity of Access (15% from 6 measures) 2. Clinical Outcomes & Recovery (50%) 3. Reduced Disability WSAS (10%) 4. Employment Outcomes (10%) 5. Patient Satisfaction and Choice (15%) These outcome areas represent NICE indicated quality standards Evidence Based Practice (EBP) together with IAPT quality standards Practice Based Evidence (PBE) from the analysis of Year one data (see Gyani et al report)

Relieving distress, transforming lives Data Being Gathered from 22 Pilot Sites Patient level activity, outcomes & experience data Demographic & SLA data, to support the Access Domain (by 28 th September from commissioners) Fully absorbed cost breakdown by contact and type of intervention (completed 12 th October) A sample of Mental Health PbR Care Clusters (end October?)

Relieving distress, transforming lives Patient Level Data Monthly Submissions IAPT Minimum Data Set (MDS) (50 items) flowed to the Information Centre under the ISB notice. IAPT Additional PbR Dataset (33 items, e.g. PEQ scores) also flowed to the Information Centre using the same process as the MDS

Relieving distress, transforming lives One Off Data Collection from Pilot Sites Cost Data –Fully absorbed (i.e. direct, indirect & overheads) –High & Low Intensity –Intensity Mapped to Therapy Type and Staff Role –Hourly Costs Demographic Prevalence Data –Over 65s –BME SLA Volume (by Intensity of Therapy) Mental Health PbR Care Clusters

Relieving distress, transforming lives Analysis Plan: Two Stages Stage 1 –Based on first 5 month’s data –Informs a discussion paper published mid-December –Informs initial findings (including 2013/14 recommendation) published February 2012 with Final MH PbR Guidance Stage 2 –Based on all 9-month’s data –Informs final findings published April 2013

Relieving distress, transforming lives Project Plan IAPT PbR Milestone Plan (11/06/2012) Apr- 12 May- 12 Jun- 12 Jul- 12 Aug- 12 Sep- 12 Oct- 12 Nov- 12 Dec- 12 Jan- 13 Feb- 13 Mar- 13 Collect & submit patient level data from pilots sites Collect & submit sample MH cluster & resource usage from pilots Define cost collection methodology Collect costs Collect demographic data Scope analysis & modelling Tendering process Accept Tender ♦ Data Preparation & Statistical Analysis Issue Discussion Paper ♦ Issue 2013/14 guidance ♦ Further Data Preparation and Statistical Analysis Compile Final Report Handover to Mainstream PbR Team

Relieving distress, transforming lives Deliverables of the Analysis 1.Analysis of Cost Recovery 2.Analysis of the Feasibility of Data Collection 3.Analysis of the Affordability 4.Service User Analysis 5.Lessons Learned Analysis 6.MH Cluster & Cost Analysis 7.Demographic Profile 8.Usage Profile 9.Case-mix Profile 10.Referral, Satisfaction, Choice & Outcomes Profile 11.Work & Social Adjustment Scale (WSAS) Analysis

Relieving distress, transforming lives Cost Recovery Analysis Matrix –Percentage of currency by month & by provider Measures –Variance between providers –Variance between commissioners –Variance between months (Stability/volatility) –Do services performing well recover costs –Are services performing poorly incentivised to improve –Are there any perverse incentives

Relieving distress, transforming lives Feasibility of Data Collection Measures of Data Quality from Information Centre Measures of Data Completeness Analysis of Lessons Logs from Provide rs Affordability Compare PbR Payments to Block Contracts

Relieving distress, transforming lives Service Users Not Paid For (less than two sessions) Two Sessions Only No Clinical Improvement or Deterioration Data Completeness of Patient Experience Questionnaires Lessons Learned

Relieving distress, transforming lives Lesson Learned Any Other Lessons from Commissioners & Providers Mental Health Clusters Correlation Between Cluster and IAPT Episode Cost?

Relieving distress, transforming lives Demographic Profile The proportion of the service users that are of working age The proportion that are in the vulnerable age (16-24) in terms of employment outcomes? The proportion of aged 65 and over The proportion of each ethnicity The proportion by gender An Analysis of if any group above is under-represented

Relieving distress, transforming lives Usage Profile The average number of therapy sessions patients have The proportions of High Intensity and Low Intensity therapy sessions Case-Mix Profile By Mental Health Clusters

Relieving distress, transforming lives Referral, Satisfaction, Choice & Outcomes Profile Proportion of patients treated that were below caseness when assessed Proportion of disabled patients treated that were below caseness when assessed Proportion of self-referred patients treated that were below caseness when assessed Proportions of self-referrals, by age, ethnicity, gender and disability Correlation between referral mode and satisfaction Proportion of patients with a preference for treatment option Correlation between clinical improvement/recovery and satisfaction Correlation between clinical improvement/recovery and choice Correlation between clinical improvement/recovery and diagnosis

Relieving distress, transforming lives Work & Social Adjustment Scale (WSAS) Disability (initial mean WSAS) Clinical Outcomes (change in mean WSAS) Cost of the Patient Episode (change in mean WSAS)

Relieving distress, transforming lives Not part of the scope of the Project at this stage: Price & Cost Unbundling Incentivising Quality & Outcomes, Beyond Goals What-if Analysis –Sensitivity Analysis Changes to elements within domains Changes to proportions assigned to each domain –Iterative optimisation Maybe Required if a National Tariff is to be Developed