Mental Health Payment
Martin Campbell
Head of Pricing
Overview
 What’s the rationale for a new payment approach for
mental health services
 How far have we got in implementing a new payment
approach for working age adults and older people
 What do we need to do to bring in new approaches for
other MH services
2
The challenge
Investment
patterns by
commissioners do
not necessarily
reflect need
although
allocations now do
Weighted Expenditure on Mental Health Services 2011
Source: Department of Health
3
Mental Health Payment system needs to
support delivery of improved mental health
Enhanced
personalisation
and choice
Reduction of
variation in
mental health
services
Value
for
money
Quality
Indicators
Mental
Health
payment
Improved,
comparable
data
Parity of
esteem
Service
Organisation
and SLM
Recovery
and policy
objectives
Mental
Health
Payment by
Results
The model at its simplest
Currency Model
Activity
(intervention)
Cluster Algorithm
Mental
Health
Clustering
Tool
Care Transition
Protocols
Quality Indicator 1
£
Quality Indicator 2
Quality Indicator 3
Quality Indicator 4
21
Clusters
Resource
utilisation
(Tariff)
Quality
Indicators
1
2
3
Mental
Health
Payment by
Results
What’s been achieved nationally?
 Care clusters made available for use – February 2010
 Costing data collected on a cluster basis – September 2011
 All service users allocated to care clusters – December 2011
 Mental health currencies mandated – April 2012
 Quality measures available for use – April 2013
 Cluster pricing methodology – April 2014
 HSCIC quality and outcomes reports – July 2014
6
What’s the data showing
• 81% of in-scope service users now assigned to a cluster,
more than 95% in the top ten providers
• 70% of initial cluster allocations meet the “red-rules” set
out in the clustering booklet
• 72% of service users being re-clustered within the
suggested maximum review periods
7
What’s been achieved at the local level?
• 2014 HFMA survey - 41 out of 59 trusts responded
• 95% in regular dialogue with commissioners in relation to the payment mechanism
• 68% have block contracts in place with a shadow tariff for 2014/15
• 95% had used the methodology for calculating local prices as set out in the National tariff
document
• 57% envisaged movement towards national prices by 2019/20
• 72% use active caseload monitoring to ensure that reported activity is accurate
• 66% reasonably confident that in scope patients were clustered correctly as initial
assessment, rising to 73% on re-clustering following review
• 61% using a PROM short WEMWBS being the most popular
• 78% use HoNOS as the clinical rated outcome measure (CROM)
8
Development of other services
 CAMHS
• Pilots collecting data on resource usage using CYP IAPT dataset
• Some initial thoughts on clusters but will be reviewed when data collection
ends summer 2014
• Currencies available by 2015
 Forensic services
• Second year of piloting proposed currencies
• Currencies available for use from late 2014
 Learning Disabilities
• Data collection to test potential approach
• Engagement with service users, provides and commissioners during 2014
 Psychological medicine
• Tool kit being prepared as part of supporting guidance for 2015-16
Aim is to have alignment and support integration and transitions between
services
Mental Health Payment by Results