oxfordshire clinical commissioning group contracting to support integration for mental health and...
TRANSCRIPT
OxfordshireClinical Commissioning Group
Contracting to support integration for mental health
and older people
Oxfordshire CCG’s approach to contracting for outcomes
OxfordshireClinical Commissioning Group
This presentation
What do we mean by an outcomes based contract?
Our approach to procurement Developing the contract and contract
negotiation
OxfordshireClinical Commissioning Group
What do we mean by an outcomes based contract?
One contract incentivised to deliver outcomes One contract that incorporates all of the services and
investment needed to deliver those outcomes One plan for the patient across all of the different
providers One system of clinical governance and accountability One database linked into national datasets Delivery
of outcomes…but not at the expense of quality Uses PbR clustering and coding to monitor activity Outcomes linked to the delivery of recovery and well
being Contract length that supports transformational
ambition-5+2
OxfordshireClinical Commissioning Group
Approach to procurement (1)Know your market and your
organisationJanuary 2013 Phase 1 market analysis
included option appraisal as to how providers might be chosen
November 2013 Phase 2 had included more market analysis and determined two options Proceed with current providers via a
service review exercise Proceed to competitive procurement
OxfordshireClinical Commissioning Group
5 Commercial Overview5.7 OPTIONS FOR ROUTES TO CONTRACT
State of Market(number of providers)Few many
Complexity of service
Degree of Integration required
Commissioning structure options Commissioning route options
Full competition Simple Limited Range of providers competitively procured
ITT or Framework
Full competition Complex Full Consortia competitively procured Competitive dialogue
No competition Simple Limited / Full
Development of the market Development of the market
No competition Complex Limited Single provider Single action tender with strong partnering & incentivisation
No competition Complex Full Lead provider with back to back subcontract arrangements
Single action tender with strong partnering & incentivisationDiligence on subcontractors
Some competition in specific service areas but with one dominant (lead) provider
Complex Full Lead provider with competition for subcontracts Or Specialist integrator with back to back arrangements to dominant provider and sub contract providers.
Single action tender for lead with strong partnering & incentivisationCompetitive Dialogue for subcontractorsOr As above with Competitive Dialogue for integrator
Some competition in specific service areas with several dominant (key) providers
Complex Full Lead provider with competition for subcontracts
Or Specialist integrator with back to back arrangements to key providers and sub contract providers
Competitive dialogue for lead provider roleSingle action tender for key providers with strong partnering & incentivisationCompetitive Dialogue for subcontractorsOr As above with Competitive Dialogue for integrator
OxfordshireClinical Commissioning Group
5 Commercial Overview
There are pros and cons for each Commissioning structure and when assessing the optimal one these should be taken into account to understand which Pros and Cons have a material bearing on the situation and which Cons can be mitigated. The key Pros and Cons are set out below, but are assessed on a scheme level in each service section.
5.8 GENERIC PROS AND CONS OF EACH CONTRACTING ROUTE
Potential commissioning structure
Pros Cons Other considerations
Range of providers competitively procured
Competition in the market can drive quality and VfM
Risk of poor integration Integration risk held by the Commissioner
Consortia competitively procured
Competition in the market can drive quality and VfM
Some risk of lack of integration requires strong governance
Contract awarded to Single provider
Enables development of partnering collaborative approach
No contestability or pressure to drive quality Quality may be sub-optimal in non core areas
Lead provider with back to back subcontracting arrangements
Specific services are provided by speciality providers Integrator risk with provider
Limited contestability or pressure to drive quality Risk of compounding of required profit
Back to back arrangements with step in rights may be required
Lead provider with competition for subcontracts
Specific services are provided by speciality providers Some competition for specific services Integrator risk with provider
Limited contestability or pressure to drive quality for lead provider Risk of compounding of required profit
Specialist integrator with back to back arrangements to key and sub contract providers
Potentially some element of competition
Requires strong contractual arrangements whereby risk is transferred to the providers and the integrators can effect change
OxfordshireClinical Commissioning Group
Approach to procurement (2)
January 2014 Gateway review and increased emphasis on integration within system
February 2014 Decision to work with current providers
June 2014 Issued invitations to participate in most capable provider assessment
OxfordshireClinical Commissioning Group
Most Capable Provider ProcessAssessment of
Provider engagement and demonstration of appetite
Acceptance of key principles Capability
Invitation issued with assessment criteria and providers given 40 working days to submit written proposal
Evaluation
OxfordshireClinical Commissioning Group
Developing the contract and contract negotiation:Developing the Contract: National standard contract MCP provider submission used to inform the
development of the contract Prime Contractor model v’s Allied Contract Exercise national flexibilities where
appropriate to your approach e.g. local variations, local modifications & local prices
Secure legal support
OxfordshireClinical Commissioning Group
Developing the contract and contract negotiationContract negotiation: Clearly define the negotiation timetable Set out requirements/expectations of the negotiation
meetings and roles of attendees Ensure sufficient administration support to accurately
capture agreements/actions with clear deadlines Schedule enough time to prepare for negotiations and
pre-meets – over estimate Issue a full contract in advance of commencing
negotiations Make use of technical sub-group meetings to inform
negotiation meetings
OxfordshireClinical Commissioning Group
Contacts OBC Programme Lead:
Catherine Mountford [email protected]
Head of Contracting and Procurement Hannah Mills
OxfordshireClinical Commissioning Group
Outcomes and metrics for mental health
Outcome Proposed metric
People will live longer Mortality rate of people with SMI
People will improve functioning Recovery star; progress through PbR clusters; effective discharge
Timely access to support Emergency response: 2 hours
Carers will feel supported Surveyed on case review
People will have a meaningful role People in paid work, structured volunteering and structured education
People will have stable accommodation
People in settled home, including on supported housing pathway
People will have better physical health
Reduced used of urgent care pathway; “normal” BMI; smoking reduction