1. Integrated Personal Commissioning (IPC) Finance Project Group Financial Model Development

2. Goals People with complex needs and their carers have better quality of life and can achieve the outcomes that are important to them and their families through greater involvement in their care, and being able to design support around their needs and circumstances. Prevention of crises in people’s lives that lead to unplanned hospital and institutional care by keeping them well and supporting self- management as measured by tools such as ‘patient activation’ – so ensuring better value for money. Better integration and quality of care, including better user and family experience of care. Purpose Make a long term commitment and set a clear ambition to develop, test and implement new integrated funding models. Develop a patient level data set covering cost and activity in health and social care.. Finance Model  Use model to analyse input activity and costs across health and social care.  Outputs to show average costs per person for the cohort across the different settings of care.  Show the distribution of costs for patients within the cohort.  Forecast average costs for 5 years using assumption made and agreed at the Finance Project Group 2 Group purpose and developing the Finance Model

3. 3 Finance Model Stages Stage 1 Assumptions Stage 2 Data Input Stage 3 Output Data Stage 4 Analyse Outputs Calculation With Provider and project group engagement analyse results to ensure correct data and costs being picked up for identified cohort. Re-Run model with changes. Distribution of costs displaying average costs of cohort in a variety of outputs. Build linked data set to include - Acute, Community, Mental Health, Primary Care and Social Care data. Service Changes - Changes in Activity, Costs and new services Cost Assumptions - Cost uplifts and efficiency Activity - Demographic and Non Demographic

4. 4 Assumptions and Data Sources Data Assumptions - Cohort is based on a diagnosis at any time in the patient record and include one long term condition from Asthma, COPD, CHD, Dementia, Diabetes, Heart Failure or Stroke. Patients may have multiple long term conditions. - Growth data for Portsmouth CCG based on ONS calculations’ - Activity has not been increased to take into account the population that is not covered by the HHRA. GP Activity in the model therefore covers 78% of the Portsmouth population. Data Sources Acute - SUS Data with no restriction on provider. Community- SUS Data and local dataset for Solent and Southern Health. Mental Health- SUS Data and local dataset for Solent only. GP - HHRA for 78% of Portsmouth CCG Population IPPDD- Contract information. Local Prices. Prescription Data- Taken from Dec 15 HSCIC BNF report, where possible for ingredient cost.

5. 5 Patient Demographics – Patients Diagnosed with LTC Key Messages 1417 Patients in linked data set. All deceased patients have been removed from the cohort. Split of the cohort is 47% Males and 53% Females Specialised Activity has been removed from linked data Count of Unique Patients by Gender Total No. LTCMFGrand Total 1127109236 2190206396 3171213384 489111200 55160111 6243357 710919 84711 9213 Grand Total6687491417

6. 6 Patient Demographics – Age Bands Key Messages As the age of the population increases the amount of LTCs increases. Percentage of Patients by Age Band Number of LTC1 LTC2 LTC3 LTC4 LTC Age50To5419%8%3% Age55To5913%11%7%4% Age60To6416%12%7%8% Age65To6911%14%13%6% Age70To7413%12%13%12% Age75To799%14%16% Age80To846%13%15%20% Age85To896%9%15%16% Age90To944%5%9%14% Age95+3%2%3%4%

7. 7 Patient Profiling – LTCs by Diagnosis Number of Patients with Long Term Conditions by Diagnosis Long Term Condition1 LTC2 LTC3 LTC4 LTC5 LTC6 LTC7 LTC8 LTC9 LTC No. Patients Asthma31442791022 1126 COPD594529157711 164 Coronary Heart Disease445662221712331220 Dementia281043 45 Diabetes Mellitus53474217 7 183 Heart Failure45441 18 Hypertension 120153874019105 434 Stroke1721151232 1 71 Other *048 31168311156 No of Patients2363963842001115719113 1417 *Other includes – Atrial Fibrillation, Cancer, Depression, Epilepsy, Hypothyroidism, Learning Disabilities, Mental Health, Osteoporosis, Palliative Care, Peripheral Arterial Disease, Rheumatoid Arthritis. Key Messages 55% of the cohort have either 2 or 3 LTCs. Reduces to 52% when looking at cost apportionment. Expensive average costs however are for those with multiple LTCs (7-9)

8. 8 Patient Profiling – LTCs by Diagnosis *Other includes – Atrial Fibrillation, Cancer, Depression, Epilepsy, Hypothyroidism, Learning Disabilities, Mental Health, Osteoporosis, Palliative Care, Peripheral Arterial Disease, Rheumatoid Arthritis. Key Messages The current linked data total cost £9.8m This doesn’t include 22% of HHRA or Social Care Information. Hypertension is a large driver in the cohort – Secondary driver for these patients to be analysed. Total Cost by Number of Long Term Condition Long Term Condition 1 LTC 2 LTC 3 LTC 4 LTC 5 LTC 6 LTC 7 LTC 8 LTC 9 LTC Total Asthma89,281200,392197,98543,76362,94128,59326,88136,885686,720 COPD298,505271,657204,345115,96472,86650,6494,63213,1261,031,743 Coronary Heart Disease 148,043314,171379,478200,161138,131118,50347,04921,1915,6831,372,410 Dementia187,18249,92614,83424,357276,300 Diabetes Mellitus 360,733337,887366,239133,810130,797109,1371,438,602 Heart Failure19,24038,19832,09019,0035,309113,840 Hypertension661,6001,097,712654,487350,330200,853139,42454,9613,159,367 Stroke68,039118,895108,87687,68225,45310,5943,537423,077 Other334,080481,139266,521142,25559,37327,90217,90613,7901,342,966 Total Cost of Patients1,171,0232,326,8062,882,6981,545,748928,082577,702245,888110,72156,3589,845,025

9. 9 Cohort - Asthma Key Messages Acute activity forms 70% of the Asthma Cohorts costs. Asthma patients with 6 or more LTCs cost 3 times as much as those with 2 or 3 LTCs Top 10 Specialities Usage of Acute SpecialtyTotal GENERAL MEDICINE126,011 TRAUMA & ORTHOPAEDICS72,731 GASTROENTEROLOGY40,343 RESPIRATORY MEDICINE32,614 A&E28,618 Grand Total300,317 Asthma Total Cost by Care Setting Care SettingTotal Acute477,564 Community80,797 GP38,399 Mental Health25,098 Prescribing64,861 Grand Total686,720

10. 10 Cohort - COPD Key Messages Acute activity forms 63% of the Asthma Cohorts costs. Prescribing forms larger part of cost then other LTC diagnosis Top 5 Specialities Usage of Acute SpecialtyTotal GENERAL MEDICINE216,675 RESPIRATORY MEDICINE92,625 TRAUMA & ORTHOPAEDICS76,029 A&E38,801 CARDIOLOGY29,068 Grand Total453,198 COPD Total Cost by Care Setting Care SettingTotal Acute652,585 Community94,253 GP69,144 Mental Health43,628 Prescribing172,133 Grand Total1,031,743

11. 11 Cohort – Coronary Heart Disease Key Messages Acute activity forms 63% of the Coronary Heart Disease Cohorts costs. High costs in a number of specialities CHD Total Cost by Care Setting Care SettingTotal Acute911,489 Community197,490 GP46,698 Mental Health45,692 Prescribing171,041 Grand Total1,372,410 Top 5 Specialities Usage of Acute SpecialtyTotal GENERAL MEDICINE220,972 CARDIOLOGY98,192 TRAUMA & ORTHOPAEDICS80,384 A&E50,620 COLORECTAL SURGERY46,865 Grand Total497,033

12. 12 Cohort – Dementia Key Messages Acute activity forms 50% of the Dementia Cohorts costs. However Dementia patients access a higher volume of Mental Health and Community Services than other cohorts. Dementia Patients forms a smaller total cost than other cohorts. Dementia Total Cost by Care Setting Care SettingTotal Acute139,512 Community44,131 GP12,771 Mental Health49,616 Prescribing30,269 Grand Total276,300 Top 5 Specialities Usage of Acute SpecialtyTotal GENERAL MEDICINE50,536 GERIATRIC MEDICINE24,276 TRAUMA & ORTHOPAEDICS18,016 GENERAL SURGERY7,550 A&E7,148 Grand Total107,526

13. 13 Cohort – Diabetes Key Messages Acute activity forms 61% of the Diabetes Cohorts costs Average costs over No of LTCs fairly static. Diabetes Total Cost by Care Setting Care SettingTotal Acute882,447 Community220,946 GP83,850 Mental Health57,936 Prescribing193,422 Grand Total1,438,602 Top 5 Specialities Usage of Acute SpecialtyTotal GENERAL MEDICINE195,214 CARDIOLOGY107,101 TRAUMA & ORTHOPAEDICS82,988 COLORECTAL SURGERY50,161 GASTROENTEROLOGY44,153 Grand Total479,617

14. 14 Cohort – Hypertension Key Messages Acute activity forms 64% of the Hypertension Cohorts costs. Hypertension is the most expensive cohort. Hypertension Total Cost by Care Setting Care SettingTotal Acute2,037,455 Community451,518 GP145,125 Mental Health205,318 Prescribing319,951 Grand Total3,159,367 Top 5 Specialities Usage of Acute SpecialtyTotal GENERAL MEDICINE537,080 TRAUMA & ORTHOPAEDICS243,494 CARDIOLOGY223,229 GASTROENTEROLOGY103,406 A&E101,222 Grand Total1,208,431

15. 15 Cohort – Stroke Key Messages Acute activity forms 69% of the Stroke Cohort Costs. Average costs stable as LTCs increase. Stroke Total Cost by Care Setting Care SettingTotal Acute290,846 Community48,011 GP24,209 Mental Health11,113 Prescribing48,898 Grand Total423,077 Top 5 Specialities Usage of Acute SpecialtyTotal GENERAL MEDICINE72,743 TRAUMA & ORTHOPAEDICS45,740 STROKE MEDICINE37,406 CARDIOLOGY21,625 GENERAL SURGERY18,019 Grand Total195,533

16. 16 Year 2 – Current Workstreams Finance Model Personal Budgets Social CarePathwaysData QualityCohorts Outliers HRG GP Activity (TPP) Re-Run for 15/16 Data Data sharing agreement. Link to Health Data. To Include Children and Young People Adults with Learning Disabilities. Identify key pathways. Calculate average costs. Consider before and after - Evaluation Calculate PB value. Link with Care Planning and Support / PB work stream.

17. 17 Mean Vs Median Key Messages There is a large cost difference between the mean and median due to expensive outliers. ConditionMeanMedian Asthma £ 5,450.16 £ 3,310.04 Atrial Fibrillation £ 8,171.04 £ 6,208.69 Cancer £ 7,342.46 £ 6,450.82 Chronic Kidney Disease £ 7,264.01 £ 5,145.33 COPD £ 6,252.99 £ 5,101.18 Coronary Heart Disease £ 6,210.00 £ 4,116.66 Dementia £ 6,139.99 £ 5,313.13 Depression £ 8,990.22 £ 8,078.05 Diabetes Mellitus £ 7,818.49 £ 5,445.02 Epilepsy £ 10,683.71 £ 6,041.50 Heart Failure £ 6,324.46 £ 3,897.21 Hypertension £ 7,279.65 £ 5,184.16 Hypothyroidism £ 9,630.36 £ 4,568.66 Learning Disabilities £ 21,219.16 £ 9,248.65 Mental Health £ 8,618.48 £ 7,410.58 Osteoporosis £ 7,008.98 £ 5,830.00 Palliative Care £ 12,731.42 Peripheral Arterial Disease £ 4,419.43 £ 3,424.58 Rheumatoid Arthritis £ 9,561.34 £ 4,536.66 Stroke £ 5,958.83 £ 4,206.00

18. 18 Mean Vs Median – Excluding outliers Key Messages Excluding the top and bottom 10% of the data to remove outliers makes the data less variable. ConditionMeanMedian Asthma £ 4,375.17 £ 3,253.76 Atrial Fibrillation £ 7,042.57 £ 6,160.01 Cancer £ 6,578.84 £ 6,305.66 Chronic Kidney Disease £ 6,296.59 £ 4,484.00 COPD £ 5,731.50 £ 5,066.09 Coronary Heart Disease £ 5,444.20 £ 4,156.94 Dementia £ 5,721.92 £ 5,284.96 Depression £ 8,990.22 £ 8,078.05 Diabetes Mellitus £ 6,727.05 £ 5,435.70 Epilepsy £ 8,372.68 £ 5,985.99 Heart Failure £ 5,710.87 £ 3,897.21 Hypertension £ 6,486.48 £ 5,086.00 Hypothyroidism £ 6,749.27 £ 4,315.99 Learning Disabilities £ 21,219.16 £ 9,248.65 Mental Health £ 7,850.11 £ 7,065.08 Osteoporosis £ 7,008.98 £ 5,830.00 Palliative Care £ 12,731.42 Peripheral Arterial Disease £ 3,746.92 £ 2,865.16 Rheumatoid Arthritis £ 7,625.17 £ 4,448.91 Stroke £ 5,354.67 £ 4,125.33

19. 19 PB Value - Average Costs 1st Diagnosis / No of Long Term Conditions123456789Total Asthma2,8804,5547,3334,8636,29414,29613,440036,8855,450 COPD5,0596,0377,0467,73110,4097,2364,63213,12606,291 Coronary Heart Disease3,3655,6106,1219,0988,1259,87515,6837,0645,6836,238 Dementia6,6854,9933,7098,119000006,140 Diabetes Mellitus6,8067,1898,7207,8717,69415,5910007,861 Heart Failure4,8107,6408,0224,7515,30900006,324 Hypertension05,5137,1757,5238,75810,57113,94210,99207,280 Stroke4,0025,6627,2587,3078,4845,29703,53705,959 Other *06,96010,0248,5978,8917,4229,30117,90613,7908,609 Totals33,60854,15865,40765,86063,96570,28856,99952,62556,35860,152 1st Diagnosis / No of Long Term Conditions123456789Total Asthma4521,5742,6546039632987,489010,8201,681 COPD1,1981,1551,4372,1732,2581,89553724901,451 Coronary Heart Disease7308871,9932,7691,5343,1164,3742,2011,4931,775 Dementia2,9401,4567542,798000002,404 Diabetes Mellitus2,3422,3452,3869452,64910,2410002,606 Heart Failure1,8872,7515,4205,013000003,252 Hypertension01,6202,5222,2462,1753,5472,0992,55802,249 Stroke7001,4091,2707943,5901,528012001,159 Other *02,1943,7213,8761,6172,0203,4195,2911,8212,976 Totals10,24915,39022,15821,21614,78622,64517,91810,41914,13419,554 Average cost of LTC over No of Long Term Conditions – Includes all linked data set. Average cost of LTC over No of Long Term Conditions – Only Community and Mental Health Data * Other Includes - Cancer, Depression, Epilepsy, LD, MH, Palliative Care, Arthritis

20. 20 Challenges Culture Information Governance Breaking Block Contracts Processes Funding Resources ConsentEngagement

21. 21 Partners