1. Outcomes Based Commissioning
Developing a segmentation approach in Southwark
FPH Annual Conference 2017 Registrar Showcase
Dr Suzanne Tang Public Health Medicine ST1
20 June 2017

2. This presentation will focus on Public Health’s contribution towards a new commissioning approach
LEARNING OBJECTIVES
This session will explore:
The national context for transforming health and social care
Southwark’s approach to transformation through capitated budgets
Public Health’s contribution to the process
The impact of our work on the development of outcomes based commissioning
My learning from this experience that can be translated into future practice
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3. The Five Year Forward View recognised that new care models require new commissioning approaches
INTRODUCTION
The 2014 NHS Five Year Forward View (FYFV) highlighted three gaps:
Funding and efficiency
Health and wellbeing
Care and quality
The current payment system does not incentivise integration:
Tariff-based payment models drive activity
Block contracts contain activity but with no quality incentive
Separate contracts for each aspect of care may further disincentivise integration
New care models are promoted as a way to close these gaps
5YFV identified three gaps that need to be addressed to improve health and social care in England:
New care models such as multispecialty community providers (MCP)
However, the current payment system does not always support delivery of integrated and co-ordinated care:
Tariff-based payment models emphasise increased volume of activity rather than quality or outcome.
Block contracts provide a fixed payment irrespective of activity, with no incentive to deliver services beyond those contracted.
Separate contracts for each aspect of care may further disincentivise integrated care and lead to gaps in provision.
Successful implementation of these new care models therefore require new payment approaches that will provide financial incentives for providers to facilitate greater integration of care.
References
NHS (2014) Five Year Forward View
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4. In Southwark, a capitation approach using outcomes based commissioning has been proposed
SOUTHWARK CONTEXT
The Southwark Five Year Forward View
Populations over providers
Total system value
‘How’ care is delivered as well as ‘what’ care
Outcomes based commissioning (OBC)
Incentivises provider alliance formation
Incentivises integration
Emphasises prevention
Mitigates against rationing and poor quality
Segmentation can be used to drive the shift towards capitated budgets.
the Southwark Five Year Forward View sets out the case for a system-wide transformation of health and social care in order to improve outcomes in the borough. It seeks to focus on:
Populations over providers
Total system value
‘How’ care is delivered as well as ‘what’ care
A capitation approach using outcome-based commissioning (OBC) is proposed as a means of addressing all three principles by moving separate contracts into population-based contracts that focus on the improvement of outcomes:
Incentivises providers to form alliances and ensure service utilisation is aligned to need
Incentivises an integrated provider to treat people in the lowest cost and most timely manner
Encourages a greater emphasis on prevention services
The inclusion of an outcome-based payment mechanism will help mitigate the risk of perverse incentives typically associated with a capitated approach: the rationing of access to and / or reduced quality of care.
In order to achieve this significant paradigmatic shift in commissioning, the total population will be segmented into distinct groups based upon the similarity of their needs.
Population segmentation
References
NHS Southwark CCG and Southwark Council. Southwark Five Year Forward View: A local vision for health and social care: 2016/17 to 2020/2021.
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5. Public Health has acted as both catalyst and critic in this process
REGISTRAR CONTRIBUTION
OUTCOMES BASED COMMISSIONING
Challenge and shape the Commissioning Development Groups
Case note review of the mental health population who are unable to live independently
Creation of an operational roadmap highlighting key decisions and milestones that will enable the vision to be realised
DEFINE AMBITION
PROPOSE METHODOLOGIES
SUPPORT OPERATIONALISATION
We’ve challenged and shaped the Commissioning Development Groups, working with leaders in both Council and CCG
We’ve developed innovative approaches to translating theory into practice
We’ve supported the operationalisation of segmentation and identified risks and mitigation strategies
One example of my role as a Public Health Registrar in this process was to identify a coherent cohort for segmentation from a sub-population of people with Severe Mental Illness (SMI). We evaluated the epidemiology of SMI in Southwark and proposed a potential segment within this population: those with SMI who are unable to live independently outside of services. We then carried out a deeper dive case note review on a sample of this population to better understand their current service usage and identify their met and unmet health and social care needs.
We devised an operational roadmap to support the next steps in terms of identifying an alliance of providers who are able to meet the care needs of this segment and setting out the commissioning intentions and agreed outcomes for incentive payments
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6. Public Health’s contribution has created momentum in OBC and consolidated partnership working
IMPACT AND LEARNING
Our impact:
Southwark will be making a paradigmatic shift in the commissioning process
The value of Public Health expertise in commissioning and service transformation in the local authority setting has been consolidated
Collaborative working with NHS Southwark CCG and Southwark Council has thrived
My learning:
A new interpretation of the Public Health value-add
Taking a leadership role in the service transformation agenda and process
Effective communication with key partners to foster credibility and collaboration
As a result of our work, the SMI cohort was taken forward as a pilot segment for outcome-based commissioning.. Public Health will continue to support the Clinical Commissioning Group and Southwark Council in making this difficult but significant paradigmatic shift in the commissioning process to drive higher quality outcomes.
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7. THANK YOU FOR LISTENING! Dr Suzanne Tang suzanne.tang@southwark.gov.uk