LONDON--(BUSINESS WIRE)--Providing viable alternatives to activity based healthcare systems, Outcomes Based Healthcare (OBH) today launched an industry-first paper that outlines technical, legal and financial possibilities to define, measure and contract for outcomes, rather than activities, processes, or outputs of care.
The paper offers a comprehensive description and best practice guidelines for implementing the full range of outcomes based contracts, with details about how these contracts can be fitted to the existing payments system in the NHS. It addresses some of the known issues of the incumbent system that stem from the lack of insight into current spending on healthcare for large sections of the population as their health demands change.
The NHS is researching alternatives to the current cash and quality crisis1,2. The current mix of payment systems has evolved over time rather than having been developed for the current service, and it is no longer fit for purpose. True costs of care and pricing are obfuscated and increasing as a result of demographic changes and services that may not be effective. To prevent the system from becoming unaffordable and to avoid a situation where rationing services or increasing tax becomes the only viable option, several effective alternatives are outlined in the paper.
Outcomes-based approaches require multiple providers – very few outcomes can be delivered by a single provider (hospital, GP etc.) acting in isolation from the rest of the system. The outcomes-based system requires many providers to work together as a team and to be jointly accountable for the results of the care – the patient’s overall health - rather than just one piece of the care provided. The paper offers guidance for incorporating a legally sound way of paying these teams on results rather than inputs, encouraging a radically different approach to care. Taking a team approach vs. individual providers benefits the system, the patient and the taxpayer.
The North Central London (NCL) CCGs3, who commissioned this research, are collaborating to implement a Value and outcomes-based system at scale for a catchment population of 1.4 million people - focusing on people with diabetes, frail and older people, and people with severe mental illness initially. Having defined the outcomes they were seeking, they are now planning to put contracts in place for next financial year.
David Cryer, Camden’s Chief Officer leading the project across the five boroughs said: “This report is effectively a set of pragmatic guidelines that is helping Camden and our neighbouring boroughs in NCL change the way healthcare is commissioned and delivered to our population. I think the new models will be sustainable and effective: our providers are paid to deliver continuous health improvements within the available resources. This report covers major considerations and guidelines for groups rethinking the delivery of healthcare for better Value and Outcomes.”
Dr. Rupert Dunbar-Rees, former GP and founder/director at OBH, comments: “The current payment system is broken and requires a drastic shift in approach if the NHS is to remain free at the point of care. Healthcare payment incentives often work against the aim of the service; medical practitioners’ success should be based upon improving the health of a population, not one that has done the most procedures or ticked the most process boxes. This paper is a roadmap to creating a patient-centred pricing, payment and measurement structure that makes sense, and can evolve with the growing needs of the population.”
In connection with this research, Outcomes Based Healthcare offers further details that challenge the myths surrounding implementation of outcomes-based approaches, found here.
To download a copy of the new report: http://outcomesbasedhealthcare.com/Contracting_for_Outcomes.pdf
Notes to editors
1) NHS is investigating new mechanisms to address the financial crisis it is facing. Camden, Barnet, Islington, Enfield and Haringey are piloting Value and outcomes-based systems and many more are trying similar approaches. Case studies: http://www.england.nhs.uk/2014/06/25/paul-husselbee/
2) Other systems that are hospital-driven (e.g. US) could benefit from understanding that there are contractual approaches that can incentivise delivery of care in less expensive settings, and prevention of illness along Value-based principles: http://www.isc.hbs.edu/health-care/Pages/default.aspx
About Outcomes Based Healthcare
Founded in 2013, Outcomes Based Healthcare is a self-funded healthcare advisory, education and technology company offering strategic advice and educational tools for advancing medical delivery systems. For more information: www.outcomesbasedhealthcare.com.
About Capsticks
Capsticks is independently rated by The Legal 500 and Chambers UK as one of the leading health and social care law firms in the UK. The firm acts for more than 200 healthcare clients, including NHS trusts and health authorities, regulatory bodies, charities and independent healthcare providers. The firm also acts for key social housing providers and organisations within the housing sector. Recent awards in the healthcare sector include the HealthInvestor award for Legal advisors of the Year in the public sector in May 2012; the General Practice Law Firm of the Year in November 2011 and the Independent Health Association Legal Team of the Year award in August 2011 and Legal Team of the Year at Legal Practice Awards 2013. Capsticks is based in London with offices in Birmingham, Leeds and Southampton. For more information, visit: www.capsticks.com.
About North Central London (NCL) CCG
This group of CCGs covers the London boroughs of Barnet, Camden, Enfield, Haringey and Islington. CCGs are NHS organisations set up by the Health and Social Care Act 2012 to organise the delivery of some NHS services in England.
1 Into the Red? The State of the NHS’ finances- An analysis of NHS expenditure between 2010 and 2014. Lafond et al, Nuffield Trust, July 2014.
2http://www.nuffieldtrust.org.uk/sites/files/nuffield/publication/into_the_red.pdf How can the NHS payment system do more for patients? A discussion paper. Monitor and NHS England, May 2013 https://www.gov.uk/government/consultations/how-can-the-nhs-payment-system-do-more-for-patients
3 North Central London CCGs covers boroughs of Barnet, Camden, Enfield, Haringey and Islington.
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