Developing an Outcomes Framework · • Not impose excessive measurement and reporting burden on commissioners or providers • Not restrict provider innovation in supporting delivery

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DevelopinganOutcomesFramework

EllieBragan Turner

www.outcomesbasedhealthcare.com

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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?

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BridgestoHealthSegmentationModel

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Outcomesdevelopmentprocessoverview

Population segmentation

Selecting outcomes Data Outcome

specifications Measurement Next steps

Who? What? How?

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Typesofoutcomemeasures

NEW SLIDE

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Selectingoutcomes

9

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)

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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

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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?

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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

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Outcomesdevelopmentprocessoverview

Population segmentation

Selecting outcomes Data Outcome

specifications Measurement Next steps

Who? What? How?

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Technicalspecifications

• Description

• Rationale

• Populationsegment

• Numeratordescription

• Numeratordatasource

• Denominatordescription

• Denominatordatasource

• Calculation

• Typeofmeasure

• Objective

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Outcomesdevelopmentprocessoverview

Population segmentation

Selecting outcomes Data Outcome

specifications Measurement Next steps

Who? What? How?

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Measurement

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Measurement

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Outcomesdevelopmentprocessoverview

Population segmentation

Selecting outcomes Data Outcome

specifications Measurement Next steps

Who? What? How?

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Nextsteps

21

- Setavailablebudget

- Decideon:- Outcomeweightings

- Paymentbands- Targetvalues

- Monitorprogress

ContactEllieBraganTurner

ellie@outcomesbasedhealthcare.com @ebraganturner

www.outcomesbasedhealthcare.com @obh_uk