IAPT Payment by Results
Project Update
David Perton
IAPT PbR Project Manager
Department of Health
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What the Presentation will Cover
• The Currency Model
• The Data Being Collected
• The Analysis Reporting Timescales
• The Project Plan
• The Analysis to be Undertaken
• What is Outside the Scope of the Feasibility Study
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The Draft Outcomes Based Currency Model
•
The five outcome areas are:
Equity of Access (15% from 6 measures)
2.
Clinical Outcomes & Recovery (50%)
3.
Reduced Disability WSAS (10%)
4.
Employment Outcomes (10%)
5.
Patient Satisfaction and Choice (15%)
These outcome areas represent NICE indicated quality
standards Evidence Based Practice (EBP) together with IAPT
quality standards Practice Based Evidence (PBE) from the
analysis of Year one data (see Gyani et al report)
1.
•
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Data Being Gathered from 22 Pilot Sites
• Patient level activity, outcomes & experience data
• Demographic & SLA data, to support the Access
Domain (by 28th September from commissioners)
• Fully absorbed cost breakdown by contact and type of
intervention (completed 12th October)
• A sample of Mental Health PbR Care Clusters (end
October?)
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Patient Level Data Monthly Submissions
• IAPT Minimum Data Set (MDS) (50 items) flowed to
the Information Centre under the ISB notice.
• IAPT Additional PbR Dataset (33 items, e.g. PEQ
scores) also flowed to the Information Centre using the
same process as the MDS
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One Off Data Collection from Pilot Sites
• Cost Data
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Fully absorbed (i.e. direct, indirect & overheads)
High & Low Intensity
Intensity Mapped to Therapy Type and Staff Role
Hourly Costs
• Demographic Prevalence Data
– Over 65s
– BME
• SLA Volume (by Intensity of Therapy)
• Mental Health PbR Care Clusters
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Analysis Plan: Two Stages
• Stage 1
– Based on first 5 month’s data
– Informs a discussion paper published mid-December
– Informs initial findings (including 2013/14 recommendation)
published February 2012 with Final MH PbR Guidance
• Stage 2
– Based on all 9-month’s data
– Informs final findings published April 2013
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Project Plan
IAPT PbR Milestone Plan (11/06/2012)
Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar12 12 12 12 12 12 12 12
12
13 13 13
Collect & submit patient level data from
pilots sites
Collect & submit sample MH cluster &
resource usage from pilots
Define cost collection methodology
Collect costs
Collect demographic data
Scope analysis & modelling
Tendering process
Accept Tender
♦
Data Preparation & Statistical Analysis
Issue Discussion Paper
Issue 2013/14 guidance
♦
♦
Further Data Preparation and Statistical
Analysis
Compile Final Report
Handover to Mainstream PbR Team
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Deliverables of the Analysis
1.
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Analysis of Cost Recovery
Analysis of the Feasibility of Data Collection
Analysis of the Affordability
Service User Analysis
Lessons Learned Analysis
MH Cluster & Cost Analysis
Demographic Profile
Usage Profile
Case-mix Profile
Referral, Satisfaction, Choice & Outcomes Profile
Work & Social Adjustment Scale (WSAS) Analysis
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Cost Recovery
• Analysis Matrix
– Percentage of currency by month & by provider
• Measures
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Variance between providers
Variance between commissioners
Variance between months (Stability/volatility)
Do services performing well recover costs
Are services performing poorly incentivised to
improve
– Are there any perverse incentives
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Feasibility of Data Collection
• Measures of Data Quality from Information Centre
• Measures of Data Completeness
• Analysis of Lessons Logs from Providers
Affordability
• Compare PbR Payments to Block Contracts
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Service Users
• Not Paid For (less than two sessions)
• Two Sessions Only
• No Clinical Improvement or Deterioration
• Data Completeness of Patient Experience Questionnaires
• Lessons Learned
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Lesson Learned
• Any Other Lessons from Commissioners & Providers
Mental Health Clusters
• Correlation Between Cluster and IAPT Episode Cost?
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Demographic Profile
• The proportion of the service users that are of working age
• The proportion that are in the vulnerable age (16-24) in
terms of employment outcomes?
• The proportion of aged 65 and over
• The proportion of each ethnicity
• The proportion by gender
• An Analysis of if any group above is under-represented
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Usage Profile
• The average number of therapy sessions patients have
• The proportions of High Intensity and Low Intensity
therapy sessions
Case-Mix Profile
• By Mental Health Clusters
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Referral, Satisfaction, Choice & Outcomes Profile
• Proportion of patients treated that were below caseness when
assessed
• Proportion of disabled patients treated that were below caseness
when assessed
• Proportion of self-referred patients treated that were below caseness
when assessed
• Proportions of self-referrals, by age, ethnicity, gender and disability
• Correlation between referral mode and satisfaction
• Proportion of patients with a preference for treatment option
• Correlation between clinical improvement/recovery and satisfaction
• Correlation between clinical improvement/recovery and choice
• Correlation between clinical improvement/recovery and diagnosis
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Work & Social Adjustment Scale (WSAS)
• Disability (initial mean WSAS)
• Clinical Outcomes (change in mean WSAS)
• Cost of the Patient Episode (change in mean WSAS)
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Not part of the scope of the Project at this stage:
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Price & Cost
Unbundling
Incentivising Quality & Outcomes, Beyond Goals
What-if Analysis
– Sensitivity Analysis
• Changes to elements within domains
• Changes to proportions assigned to each domain
– Iterative optimisation
Maybe Required if a National Tariff is to be Developed
http://www.iapt.nhs.uk/pbr
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