Commissioning for Value
The Accountable Integrated
Care System
Sept 2011
Copyright 2011 Right Care
The primary objective for Right Care is to
maximise value
• the value that the patient derives
from their own care and
treatment
• the value the whole population
derives from the investment in
their healthcare
To successfully increase value for both
patient and population, health service
reform must integrate both in an single
model; separately, they become
opposing imperatives
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Right Care for Patients – No decision about me
without me
No patient faced with a significant decision about their healthcare should decide
in the face of avoidable ignorance. All healthcare, even of the highest quality,
carries risks as well as benefits and the patient needs to know sufficient about
both and be supported in making a personal decision which is right for them.
Patient Decision Aids are important tools that the patient can use to
supplement and complement the information exchange in the consultation and
ensure that they make a high value decision which is right for them, when there
is not clinical evidence in favour of single best option. However, the clinician
needs to personalise that evidence to the unique clinical condition of the
individual, as well as to the patient’s unique values and preferences and the
patient needs to be supported by access to decision support interventions ( such
as Patient Decision Aids, short comparison tables, decision coaching etc).
Empowered patients, making informed decisions, can deliver high value care for
both the individual and for the whole population served by the service; evidence
shows that Shared Decision Making is the best route to ethical and sustainable
demand management.
Every service needs to ensure that the patient has the time and resources to
participate in decisions about their care. For this to happen, shared decision
making needs to become embedded in the culture of healthcare, which includes
clinicians, patients and the public and in the management of healthcare, both
commissioning and delivery of healthcare.
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Right Care for populations – commissioning for value
“Value in any field must be defined around the
customer, not the supplier. Value must also be
measured by outputs, not inputs. Hence it is patient
health results that matter, not the volume of
services delivered. But results are achieved at
some cost. Therefore, the proper objective is.. the
patient health outcomes relative to the total cost
(inputs). Efficiency, then, is subsumed in the
concept of value. ”
Source: Porter ME. (2008) What is Value in Health Care? Harvard
Business School. Institute for Strategy and Competitiveness. White
Paper.
…How can the NHS commission healthcare
to increased value?
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Right Care for populations – accountable, integrated, population based systems
To improve outcomes and value for their whole populations, clinicians and commissioners
need to:
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understand and address the whole population needs
address whole populations and those that appear in their clinic
manage investment in treating conditions such as at a Programme Budget level, so that
questions such as “how much is spent on diabetics and for what benefit?” can be
accounted for
ensure that the systems delivering care are integrated across the whole pathway in order
to control unwarranted variation in outcome, quality and efficiency of care and improve
patient experience
to collectively remove waste and shift health investment to higher value interventions
To deliver this commissioners need to:
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Understand how their current and future spend is related to population health outcomes
identify and address unwarranted variation in outcomes
benchmark spend and outcome against other similar populations
Integrate care across the pathway
Be clear on who is accountable and leading the system
Focus on commissioning outcomes – devolve pathway design
For your population, can you answer these
questions?
• What is Rheumatoid Arthritis (RA)?
• What are the objectives, standards
and criteria needed for an RA system
• What are the causes and scope for
of care for a population?
prevention?
• What commissioning service models
• How many people have this in my
can support the delivery of a safe,
population?
effective service, that delivers a good
• What are the best value diagnostic
patient experience and provides high
tests and treatments?
value for the commissioner and the
• How can individuals and carers be
local population
best supported long term?
• What can commissioners do to
• Is our spending on RA above or below
improve the delivery of RA service
average compared to similar
and improve the RA related health of
populations?
their population
• How do we compare, with other
populations, on activity, quality and
outcome?
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The Accountable, Integrated Care System (AICS)
What do we mean by commissioning?
Mobilise the patient
No patient should make decisions
in avoidable ignorance – the
informed and empowered
patient leads to more
appropriate and sustainable care
– embrace the Shared Decision
Making paradigm
Accountable
Integrated
Systems
…but who is accountable?
Ensure clinical and financial
accountability
In order to deliver integrated
care providers need to work
together and accept clinical
and financial responsibility for
entire programme budgets
For Patients
For Populations
Devolve Pathway Design and
Management
Commissioners should focus on
outcomes - devolving performance
management (clinical outcomes
delivered within budget) and
responsibility to develop integrated
pathways to a provider in the
programme budget pathway
Better Value
Healthcare
Understand spend and
outcome
Understand variation
commissioners and providers
need to identify unwarranted
variation and benchmark
against other populations in
order to remove waste and
shift spend to higher value
interventions
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Address whole populations
to maximise value, not just
those patients who appear in
clinic – and provide clinical
leadership to develop the
network which delivers the
service to the population and
to lead innovation
To deliver high value
healthcare, commissioners
need to manage the services
they contract at programme
budget levels – how much is
spent on diabetics and for what
outcome for the population
served?
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To learn more…
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…http://www.rightcare.nhs.uk
Or contact us on: info@qipp-rightcare.net
Copyright 2011 Right Care