Mental Health
Payment
System
Katie Brennan
Pricing Development Lead
11 December 2014
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GOV.UK/monitor
www.england.nhs.uk
Overview
• Strategic context for the health system – the Five Year Forward View
and key objectives
• Plans for mental health payment system development in 2015/16
• National Tariff Rules: how the payment system can enable better care
• Further work to support the sector
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The future NHS
The Forward View identifies three ‘gaps’ that must be addressed:
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2
3
Health &
wellbeing
gap
Radical
upgrade in
prevention
Care &
quality gap
New
models of
care
Funding
gap
Efficiency &
investment
•
•
•
•
Back national action on major health risks
Targeted prevention initiatives e.g. diabetes
Much greater patient control
Harnessing the ‘renewable energy’ of communities
•
•
•
Neither ‘one size fits all’, nor ‘thousand flowers’
A menu of care models for local areas to consider
Investment and flexibilities to support implementation
of new care models
•
Implementation of these care models and other
actions could deliver significant efficiency gains
However, there remains an additional funding
requirement for the next government
And the need for upfront, pump-priming investment
•
•
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www.england.nhs.uk
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Developing new care models
• There is wide consensus that new care models need to:
o Manage systems (networks of care), not just organisations
o Deliver more care out of hospital
o Integrate services around the patient
o Learn faster, from the best examples around the world
o Evaluate success of new models to ensure value for money
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•
There are already examples of where the NHS is doing elements of this
•
However, cases are too few and too isolated
•
The answer is not ‘one size fits all’, nor is it ‘a thousand flowers bloom’
•
We will work with local health economies to consider new options that
provide a viable way forward for them and their communities
www.england.nhs.uk
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National Tariff Rules (l)
Local payment rules apply +
1. Data: data submission for MHLDDS and reference costs based on care
clusters are mandatory regardless of the form of payment
2. Currencies: providers and commissioners must use care clusters as the
currency for payment, unless they develop an alternative approach that will
deliver better care for patients (which are subject to local variation rules)
3. Transparency: we expect all local payment contract arrangements to be
transparent and take account of patient needs
4. Accountability: We will clarify how we plan to promote compliance with
rules
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National Tariff Rules (ll)
-
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Guidance
Support
Tariff uplift
• Introduce framework
that outlines
expectations for
payment
arrangements:
• using local payment
or local variations
• how providers &
commissioners can
ensure transparency
and accountability
• Provide payment
examples that
highlight innovative
payment
arrangements to
help the sector move
toward the long-term
objectives.
• Revised approach to
setting the efficiency
factor. Consult on
the service
development uplift
for 15/16
Evidence-base (e.g. NICE)
Right treatment at the right
time & place (inc.
coordination of care)
Ensure value for patients
What is payment linked to,
ensure standards are met
-
IAPT
Liaison Psychiatry
Secure and Forensic
Outcomes based/risk share
Need constructive
engagement between
commissioners and providers
“Block” payment arrangements
Block payment may be
appropriate in some
circumstances…. such as
where it facilitates service
transformation or delivery
of the most effective care
(e.g. to facilitate greater
coordination of care).
•
•
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The value of any top-line payment needs to
be generated using a clear evidence-based
methodology
This does not mean payment needs to be
based on a calculation using cost for the
volume of service provided – it could be
based on a capitated payment approach, a
capacity payment to meet expected demand
or a combination of approaches.
All contracts, including those
associated with a block payment,
should clearly spell out:
(i) how the top-line payment value
is generated based on evidence
of costs and patent need;
(ii) the services that will be
provided under the agreement;
(iii) associated quality/outcomes
standards;
(iv) what monitoring, data collection
and evaluation are required;
(v) who is accountable for meeting
the service specification;
(vi) how over or underperformance
will be treated (including any
associated rewards or
sanctions)
What else will progress the Mental health payment system?
2015/16:
• Improving rigour of national pricesetting method (e.g., input costs,
efficiency factor)
• Transition towards long-term
system by testing new payment
designs (e.g., UEC, integrated
care)
• Initial currency design and data
collection for CAMHS
• Rollout of HSCIC quality and
outcomes reports, develop further
analysis of MHLDDS
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2016/17:
• Continued improvements to rigour,
especially costing data
• Rolling out priority long-term
payment redesigns
• Enabling widespread service
change in line with 5 year
commissioning and provider
strategies
In summary where do we hope to get to?
By April 2015 all contracts to be underpinned by an
understanding of need, evidence-based responses to need and
expected outcomes
By April 2016 all contracts to include clear incentives for the
delivery of outcomes, outcome and quality driven payment models
will have been introduced in a limited number of areas AND have
robust data on cost, activity, quality and outcomes
By April 2017 a wholesale shift to outcome-focused contracting
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Katie Brennan
Pricing Development Lead
Monitor
katie.brennan@monitor.gov.uk
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