payment by results - commissioning for outcomes
TRANSCRIPT
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Payment by Results
Commissioning for outcomes
lessons learnt so far
Megan JonesSenior Programme ManagerAlcohol & Drugs Team
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2010 Drug Strategy
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PbR will provide a constant and tough financial incentive forproviders to deliver good services (Open Public Services White
Paper July 2011)
where vulnerable users can't exercise choice for themselves, the
government should specify the result it is seeking, and then pay
the providers of the service if, but only if, they achieve that result
(Oliver Letwin, Guardian March 2012)
Putting an end to the process-fetishism of the past and savingtaxpayers billions (Oliver Letwin, Guardian March 2012)
PbR aims to transfer financial and operational risks away from the
commissioner, onto the provider, or funding bodies
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Key theme of coalition government
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Drug & Alcohol Recovery PbR Pilot
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Dec 2010
Invitations
to
Participate
May 2015
Final Report
April 2011
March 2012
Co-design
April 2012
March 2014
ImplementationPilotActivity
IndependentEvaluation
Dec 2012
Interim Report
Sep 2013
Interim Report
Sep 2014
Interim Report
May 2013
First performancedata published
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The Basic Model
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Improved health
Free of drug(s)
Provider
1
Provider
3
Self referral
GP referral
LASARS
Assessment &
tariff-setting
Referral toprovider
Confirmation
of outcomes
to trigger
payments
Advocacy forclients
Provider
2
Sustained
recovery
Relapse & re-presentation
Prime provider/provider framework
Independent
service
CJ referral
Reduced offending
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The Outcomes
Interim outcome Final outcome
OUTCOME DOMAINS
Free from drug(s) of
dependence
Health and
WellbeingReduced
Reoffending
Drug/alcohol usesignificantly improved
Abstinence
Successful completion
of treatment
Does not re-present in
either the treatment or
Criminal Justice
System for 12 months
Stops injecting
Housing situation
improves
Full course of Hepatitis
B vaccination
Achieves a normative
quality of life
COHORT
MEASURE
Reduction in the
number of provenoffences compared to
baseline
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Outcome Measures
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Restricted to measures where a baseline exists to ensureeffective modelling
Treatment Outcome Profile (TOP) was a source of data,i.e self reporting
Offending measure: matches treatment data to policedata on proven offences
Some proxy measures used (e.g. non re-presentation for
sustained recovery)
Complexity groups measure the likelihood of achievingoutcomes
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Lessons Learnt Culture change torecovery focus
PbR is time andresource-intensive: tariff-setting, contract
negotiations, data
analysis
Commissioners shareresponsibility: cannot let
services fail
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CommissioningOpportunities
Performance managementwith financial teeth
Less day to day scrutiny -reduces commissioningoverheads
Providers take onresponsibility for outcomes
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Lessons Learnt
Contracts need to be flexible;consider TUPE; & cash-flow
issues for providers
Collaboration vs competition;providers can be risk-averse;
heavy admin burden
LASARS increase treatmentnumbers; service users like
LASARS.
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CommissioningOpportunities
Change the market: goodproviders thrive, poor
ones exit
Diversify the marketcompetition, innovation,
value for money
LASARS single point ofcontact
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Risks
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Getting payments & weightings right: Individual vs cohort payments
Perverse incentives
Paying for dead weight Noise - random influences that affect outcomes
Cash-flow issues for providers
Gaming deliberate manipulation of thesystem for financial gain
Is there enough money in the system?
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Gaming
Specific risks:
Assessment of clients
Weighting and timing of payments for different PbRoutcomes
Misrepresenting or inflating success
Identifying and deterring:
Monitoring data Robust auditing and assessment of outcomes Involvement of service users in systematic, independent
assessment of their views and experiences
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Financing
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Is there enough money in the system?o Finite treatment budgets (PH Grant plus local
mainstream investment)
o Competitive tenders no new providers
Social Impact Bonds (SIB)o Social investment on basis of commitment from
govt. to pay for outcomes that result in savings to
public purse
o Majority of benefit accrues to central
government (CJ and employment benefit costs).
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PbR Useful Links
PbR DH Microsite link
http://recoverypbr.dh.gov.uk/
Lessons Learnt Link
http://recoverypbr.dh.gov.uk/2012/07/17/lessonslearnt/
PbR Performance Data Link
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/1
94007/Agenda_item_3.2_-_Pilot_data_for_publication_on_the_web.pdf
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http://recoverypbr.dh.gov.uk/http://recoverypbr.dh.gov.uk/2012/07/17/lessonslearnt/https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/194007/Agenda_item_3.2_-_Pilot_data_for_publication_on_the_web.pdfhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/194007/Agenda_item_3.2_-_Pilot_data_for_publication_on_the_web.pdfhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/194007/Agenda_item_3.2_-_Pilot_data_for_publication_on_the_web.pdfhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/194007/Agenda_item_3.2_-_Pilot_data_for_publication_on_the_web.pdfhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/194007/Agenda_item_3.2_-_Pilot_data_for_publication_on_the_web.pdfhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/194007/Agenda_item_3.2_-_Pilot_data_for_publication_on_the_web.pdfhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/194007/Agenda_item_3.2_-_Pilot_data_for_publication_on_the_web.pdfhttp://recoverypbr.dh.gov.uk/2012/07/17/lessonslearnt/http://recoverypbr.dh.gov.uk/2012/07/17/lessonslearnt/http://recoverypbr.dh.gov.uk/2012/07/17/lessonslearnt/http://recoverypbr.dh.gov.uk/