developing an outcomes framework · • not impose excessive measurement and reporting burden on...
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@obh_uk16November,2017 ©OutcomesBasedHealthcare
DevelopinganOutcomesFramework
EllieBragan Turner
www.outcomesbasedhealthcare.com
@obh_uk15November,2017 ©OutcomesBasedHealthcare@obh_uk16November,2017 ©OutcomesBasedHealthcare
@obh_uk16November,2017 ©OutcomesBasedHealthcare
Anynewoutcomesbasedpaymentframeworkshould:
• Besimple,unambiguousandunderstandable
• Beginwithachievable performancetargets,whichprogressivelybecomemorechallengingasconfidenceincreasesintheunderlyingmeasuresandtheirabilitytoimprove
• Belimitedtoarelativelysmallnumberofoutcomeswhichmattertothetargetpopulation
• Notimposeexcessivemeasurementandreportingburdenoncommissionersorproviders
• Notrestrictproviderinnovationinsupportingdeliveryofimprovedoutcomes
Source: Outcomes Based Healthcare. (2015). Structuring Outcomes Based Incentives - Contractual Options and Key Considerations.
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Outcomesdevelopmentprocessoverview
Population segmentation
Selecting outcomes Data Outcome
specifications Measurement Next steps
Who? What? How?
@obh_uk16November,2017 ©OutcomesBasedHealthcare
Outcomesdevelopmentprocessoverview
Population segmentation
Selecting outcomes Data Outcome
specifications Measurement Next steps
Who? What? How?
@obh_uk16November,2017 ©OutcomesBasedHealthcare
BridgestoHealthSegmentationModel
@obh_uk16November,2017 ©OutcomesBasedHealthcare
Outcomesdevelopmentprocessoverview
Population segmentation
Selecting outcomes Data Outcome
specifications Measurement Next steps
Who? What? How?
@obh_uk16November,2017 ©OutcomesBasedHealthcare
Typesofoutcomemeasures
NEW SLIDE
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Selectingoutcomes
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Healthy (whole population)
Maintain longevity
Prevent accidents, illness and developing long term conditions
Long Term Conditions, Disability and Organ Failure
Maintain longevity
Manage condition effectively
Limit progression of condition
Maintain autonomy
Have support for care-givers and appropriate rehabilitation services
Avoid exacerbations
Maintain existing functional ability
Frailty and/or Dementia
Maintain existing function
Maintain mobility
Being treated with dignity and respect
End of Life
Cope well with illness at the end of life
To ‘die well’ (advanced care planning, being treated with dignity, making a personal feel comfortable)
@obh_uk16November,2017 ©OutcomesBasedHealthcare
ShortlistofClinicalandSocialOutcomeMeasures
Healthy (whole population)Long Term Conditions, Disability and Organ
FailureFrailty and/or Dementia
⬇ alcohol consumption ⬇ premature deaths in serious mental illness ⬆⬆ time spent at home
⬆⬆ physical activity ⬇ smoking in LTCs ⬇ pressure ulcers
⬇ obesity ⬇ obesity in LTCs ⬇ serious falls
⬇ smoking ⬇ emergency hospital admissions ⬇ inpatient delirium
⬇ emergency admission for acute conditions that
should not usually require admission
⬇ organ failure exacerbations requiring emergency
admission⬇ UTIs, severe constipation and incontinence
⬇ days disrupted by care ⬇ dementia prevalence gap
People at the End of Life ⬇ strokes in diabetes/circulatory conditions ⬇⬇ emergency readmissions and returns to A&E
⬆⬆ people dying in preferred place of death ⬇ diabetes complications ⬆⬆ 30 and 120 day recovery from fragility fractures
⬆⬆ people identified on the Palliative Care Register ⬆⬆ early diagnosis of cancer
⬇ emergency hospital care during last weeks of life
@obh_uk16November,2017 ©OutcomesBasedHealthcare
ShortlistofPersonalOutcomes
⬆⬆ I feel more independent
⬆⬆ I feel proactive and confident in managing my health
⬆⬆ I feel I have an active and full life
⬆⬆ I spend time with friends and family, not being alone
⬆⬆ I feel in control, involved, listened to �
⬆⬆ I feel well (mentally)�
⬆⬆ I am treated with dignity and respect �
⬆⬆ I feel supported and reassured �
⬆⬆ I feel safe and secure �
⬆⬆ I do not feel anxious / depressed
⬆⬆ I am pain-free / ⬆⬆ I feel my symptoms are under control
⬆⬆ I have good nutrition �
⬆⬆ I can manage the functions of daily living
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Outcomesdevelopmentprocessoverview
Population segmentation
Selecting outcomes Data Outcome
specifications Measurement Next steps
Who? What? How?
@obh_uk16November,2017 ©OutcomesBasedHealthcare
Datamaturityforoutcomesmeasurement
Flexibility
Complexity
Quality and accuracy
National aggregate data
National acute patient-level data
Complete linked patient-level data
e.g. NHSOF, CCG OIS SUS/ HES Linked SUS/HES and primary care data
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Allocatingpeopletothecorrectpopulationsegment
Turning 65
Being diagnosed
Moving into area
Already in the population segment at the beginning of the year
Still in the population segment at the end of
the year
Moving out of area
LTC resolving
Dying
LTC
seg
men
t for
a s
ingl
e ye
ar
Diagram created in Sankeymatic
@obh_uk16November,2017 ©OutcomesBasedHealthcare
Outcomesdevelopmentprocessoverview
Population segmentation
Selecting outcomes Data Outcome
specifications Measurement Next steps
Who? What? How?
@obh_uk16November,2017 ©OutcomesBasedHealthcare
Technicalspecifications
• Description
• Rationale
• Populationsegment
• Numeratordescription
• Numeratordatasource
• Denominatordescription
• Denominatordatasource
• Calculation
• Typeofmeasure
• Objective
@obh_uk16November,2017 ©OutcomesBasedHealthcare
Outcomesdevelopmentprocessoverview
Population segmentation
Selecting outcomes Data Outcome
specifications Measurement Next steps
Who? What? How?
@obh_uk16November,2017 ©OutcomesBasedHealthcare
Measurement
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Measurement
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Outcomesdevelopmentprocessoverview
Population segmentation
Selecting outcomes Data Outcome
specifications Measurement Next steps
Who? What? How?
@obh_uk16November,2017 ©OutcomesBasedHealthcare
Nextsteps
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- Setavailablebudget
- Decideon:- Outcomeweightings
- Paymentbands- Targetvalues
- Monitorprogress