2014/15 National Tariff
Payment System &
Draft Guidance on Mental
Health Currencies and
Payment
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The Challenge for 2014/15
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Increasing Caseload and Casemix awareness
Agreeing & Implementing Quality and Outcomes
Supporting Care Pathways and Interventions
Supporting Engagement with Service Users
Develop a robust long term payment mechanism
Transactional Simplicity
Avoid de-stabilising health economies
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Monitor Mandatory requirements to be
embedded in contracts
• Use the 21 Care Clusters as contract currency
• Cluster Reviews to be completed within maximum period
in the Mental Health Clustering Tool Booklet
• MHMDS data based on data from MH Clustering Tool
• Option for moving away from block contracts using
caseload based approach and thresholds and caps
• Quality Outcomes to be agreed for each Cluster
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Basic Payment Mechanism
• Recommend use of Cluster day as the basis for contracting
• Local Cluster prices may be analysed by setting e.g. Admitted,
Non – admitted and Initial Assessment
• Active Service User caseload can be analysed by Cluster and
updated on a quarterly basis
• Agree any data cleansing methodology of the clinical caseload
within the memorandum of understanding
• Compliance with Cluster Review Periods for Active Service Users
on the caseload – to be used as a Quality Indicator metric
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Risk Management
• Memorandum of understanding based on last year’s model
• Before moving to cost and volume approach commissioners must
be assured that the thresholds set to manage financial risks reflect
ongoing contract developments
• The Memorandum of understanding should :
- Include methodology for any Data Quality improvement initiative
- Cluster information should be used to inform service change
not impose service change
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Quality and Outcomes
• Cluster Review Periods should be within the maximum
review periods specified in the Clustering Booklet and
included in the national contract.
• Compliance with the Cluster Review Period should be a
Quality Indicator metric.
• Suggestions for use of wider quality and outcome
metrics linked to
– CQUIN incentives (PREM, PROM, Clinical indicators)
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Right Balance
• The underpinning currency has been simplified
• We MUST ensure there is real emphasis given to the
Quality and Outcomes agenda.
• Need incentives and penalties
• CQUINs a tool to support this
• A focus for local agreement
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Right Pace
• Incentives and penalties need to be used cautiously
• we don’t yet know what good is for a lot of things
• Improvement trajectories may be more helpful than
absolute performance in the first instance
• MHMDS information will be available via HSCIC
• National standards, requirements and expectations will
then be possible in subsequent years
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Right Content
• 10 Data Quality Indicator metrics available via MHMDS
that give an insight into an organisation’s performance
around clustering.
• An additional 8 Data Quality Indicator metrics available
for potential local / national use
• Local agreement must be reached on which metrics to
focus on.
• These should be jointly reviewed each quarter.
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Next stages for national development
• Set out longer term direction of travel – Days /Periods
• Key issues to resolve
– Developing and using the outcome metrics in
contracting
– Deeper understanding of impact of variation in
provider landscape
– Initial Assessment
– Fit with wider integration agenda
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Where are We Now?
• We now have better information than we have ever had
• Transparency in the system challenges us to change
• The focus has to be on outcomes - this is our main challenge going
forward
• Providers and Commissioners jointly need to take hold of the
information agenda
• Jointly managing risk is critical
• We must understand and be assured of underlying data before
using it for change
• Opportunities for innovation and seizing the agenda
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