Provider considerations for delivering an outcome based contract. Croydon CCG and London Borough of Croydon

Transcription

1 Provider considerations for delivering an outcome based contract Croydon CCG and London Borough of Croydon

2 Contents Introduction and Background Introduction 4 Commissioning for Outcomes: Aims and Benefits 5 Characteristics of Outcome Based Contracts 6 Framework: Core Competencies and Capabilities Overview 8 Core Competencies 9 Capability Statements 10 What this document is: Introduction to Outcome Based Commissioning (OBC) in Croydon An indicative framework that may be expected of providers delivering Outcome Based Contracts A self-assessment for providers to consider their current maturity to identify areas for development What this document is not : Framework Assessment Appendix Framework Assessment: Summary 20 Resources used to inform the development of the framework Framework: Capabilities Summary Invitation to tender or PQQ for services The exact requirements or criteria against which providers proposals may be considered and evaluated A preferred delivery model for providers Final framework for provider competencies and capabilities as the implementation of OBC evolves framework may need to be further built upon and refined 2

3 Introduction and Background

4 Introduction The NHS and Local Authorities are currently facing a number of significant challenges. Funding pressures will continue over the coming decade, as demand across the system continues to rise. Meeting these challenges will require the system to commission and deliver services differently alongside achieving improved outcomes for their populations. As a result commissioners will need to change the way that they pay for and manage health and care services with an aim to encourage; increased integration, generate efficiencies and improvements in patient/ service user outcomes and experiences. One of the ways that Croydon CCG and London Borough of Croydon plan to respond is by reviewing the way that they contract for services. The CCG and Council are currently exploring opportunities to commission services that specifically focus on outcomes for people over 65 via a capitated budget approach. This means a budget could be on a per head of population basis, with incentives for achieving specified outcomes, necessitating providers to collaborate and plan for population healthcare management. Outcome Based Commissioning (OBC) rewards both value for money and delivery of better outcomes that are important to patients. In particular, OBC aligns incentives to outcomes relating to an entire pathway, population group (for example 65 and over in Croydon) or service. It is expected that this approach will enable and promote new delivery models that can address some of the challenges and require providers to both improve quality and manage demand. these elements in order to consider their current maturity and areas for development. This document, and associated self-assessment tool, has been developed collaboratively by the Council and CCG with the support of the PwC Alliance. It has used evidence drawn from good practice examples in the UK and abroad as well as insight from local and national sources. The framework presented in this document is indicative of the competencies and capabilities that may be expected of providers delivering Outcome Based Contracts. This document does not seek to set out the criteria against by which providers submissions could be evaluated for the delivery of services pursuant to an outcomes based contract, (if it is determined that such a contract is let). Such criteria and the commissioners detailed requirements would be set out in the appropriate OBC documents inviting proposals from potential providers. As OBC implementation in the health sector in particular (social care has had more experience of contacting on an outcomes basis) is still evolving, the provider competencies and capabilities identified may need to be further built upon and refined. Thus, this framework should be seen as an initial guide. Implementing OBC would therefore require providers to adopt different organisational forms and ways of working. It is recognised that in order to transition, providers would also need to consider the current state against future competencies and capabilities. This document sets out the competencies and capabilities that providers would need to demonstrate when delivering outcome based commissioning. In addition, it enables providers to self-assess themselves against 4

5 Commissioning for Outcomes: Aims and Benefits Potential benefits of Outcome Based Commissioning: Traditional healthcare commissioning in the NHS has tended to focus on processes: numbers of appointments, attendances, operations and procedures. But, with static funding levels, growing demand and unexplained variation in clinical care between providers, services need to be commissioned differently. Outcomes based contracts are an approach to commissioning that rewards both value for money and delivery of better outcomes that are important to patients/ service users. Applying an OBC approach to working with clinicians and stakeholders across a health care economy, and engaging patients/ service users to find out what outcomes they want, outcomes based contracts transfer appropriate risk to a provider (or providers). It also creates the circumstances and incentives that allow them to innovate and profit from success - provided they can manage costs and deliver the outcomes required. To deliver these outcomes and make the efficiency savings necessary to stay within the allocated budget, providers must collaborate, problem solve, and deliver efficient, integrated services. The approach is based on the premise that there are opportunities to improve efficiencies within the current system. This belief is consistent with results obtained elsewhere, for example in the US where they spend more on healthcare (e.g. Geisinger, PACE), and Spain where they spend less (e.g. Ribera and many others). In all of these places, capitated and outcomes based contracts and/or integrated delivery has led to improved outcomes for service users at roughly 80-85% of benchmarked costs. Delivering health and care services that meet patients needs Services are focused on delivery outcomes that are meaningful to patients/carers Ability to build a different relationship with the public and patients involving them in maximising value as well as campaigning for more resources Improved patient and service user experience by promoting service integration and reducing fragmentation Placing greater emphasis on prevention with incentives to work in partnership Improving health and care services through innovation, collaboration and integration Releasing innovative potential in providers, with clinicians taking responsibility for maximising value from the allocated budget, and delivering the outcomes the people of Croydon want Facilitating a culture of collaboration and integration between providers across the health and social care economy Delivering better value, sustainable services, and removing barriers to a more integrated approach. Realising efficiencies in the system Using a contract duration that promotes investment in prevention, quality improvements and working practices to deliver savings and efficiencies over the longer term Reducing duplication and transaction costs across organisations Reducing the number of KPIs to those that are necessary with a focus on outcomes 5

6 Characteristics of Outcome Based Contracts In response to increasing challenges and pressures healthcare systems across the world are considering different ways to commission and deliver services. Examples from healthcare systems have emerged nationally and internationally. The development of this framework has considered the characteristics of these to inform the core competencies and capabilities presented in this document : Characteristics of organisations and systems delivering outcome based contracts: Multiple organisations involved in delivering health and care services covered by a single contract covering a pathway or a defined population group A focus on integration and collaboration between organisations providing services resulting in more multi-disciplinary working Ability of a provider to manage and co-ordinate the care of individuals along the full length of clinical and social care pathways Proactive management of population groups to inform early intervention and prevention Integrated IT solutions to support collaboration and sharing of information Treating and supporting patients in different, more appropriate, settings as a result of improved co-ordination and flexibility within the contracts Increased involvement and engagement of patients/ service users in the design, delivery and improvement of new and existing services New funding and contracting arrangements, such as capitated, incentivised budgets/payments and, longer-term contracts, are used depending on the scope of the contract Another element for consideration is the development of delivery models and mechanisms to manage the delivery of larger, longerterm contracts covering a pathway or population group. Each model has benefits and drawbacks that providers and commissioners need to consider when designing future contracts. The short summary below sets out some of the most commonly referred to models: Examples of contracting delivery models: Alliance Contracting: Typically a commissioner led contracting mechanism which aims to incentivise collaboration between a number of providers, who cooperate to deliver a particular service or an interrelated set of services. Providers enter into linked contracts with commissioners and are evaluated collectively. Each party maintains internal controls with shared risk/reward. Joint Venture: Providers jointly create a new vehicle to facilitate provision of integrated care. The agreement specifies nature, responsibilities, governance but the organisations maintain their individuality. Prime Contracting: A single provider assumes all responsibility and leads integration of a whole pathway through subcontracts with other providers. Commissioners hold a single contract with prime contractors. The prime contractor may be an existing provider or a broker or integrating organisation. Prime Provider: A main provider provides the pathway or service. The provider sub-contracts parts of the pathway, where needed. Commissioners hold a single contract with this provider who also provides the majority of the care pathway. Full integrated care contract: A single entity assumes all responsibility and leads/provides Services for an entire care pathway. 6

7 Framework: Core Competencies and Capabilities

8 Framework: Overview As set out, an outcome based approach to commissioning will require new ways of working between providers of health and care services to deliver better outcomes for patients and service users across a pathway or population group. To respond providers will need to adapt and develop capabilities as well as potentially operating on a different scale. This framework is designed to give providers some insight into what may be expected. Core Competencies and Capabilities The framework defines the skills and attributes that providers will need to demonstrate when delivering outcome based contracts to better meet the needs of their populations: Core competencies describe the overarching ability of providers to manage and deliver OBC contracts and the range of health and social care services included within them. Competencies can be considered in three key areas: Technical; Relational; and Developmental. Capabilities are the specific functions that enable delivery of coordinated care and underpin the core competencies. Some of the capabilities relate more to some competencies than others but strength should be demonstrated across them all. Eight capabilities have been identified per the diagram opposite. Focusing on providers competencies and capabilities, rather than resources (e.g. number of staff), reflects a different relationship between commissioner and providers that is in line with moving to delivery health and social care that is less fragmented and engages clinicians, practitioners and the public more. Attainment of the competencies and capabilities should mean that providers will be able to demonstrate high standards of professional care. National Standards Alongside the framework it is expected that providers will adhere to national requirements and measures of care (e.g. Care Act 2014, NHS Constitution, CQC guidelines, London Quality Standards). Similarly providers should be able to demonstrate adherence to other requirements such as health and safety and, equality and diversity. These specific measures have not been included as part of this framework. 8

9 Framework: Core Competencies Core competencies describe the capabilities required by providers/groups of providers to manage and deliver outcome based care which provides value for money. There are three overarching competencies that provider organisations will need to collectively demonstrate to support the delivery of an outcome based contract: Technical; Relational; and Developmental. These competencies will help ensure that the organisations will collectively have the appropriate capability and capacity to deliver co-ordinated care services that are both safe and effective and, demonstrate a high standard of professional care. Technical Having the right infrastructure, systems and processes to support the planning management and, delivery of health and care services within the contract. Technical capabilities should enable the ongoing improvement in performance and patient care as well as an ability and commitment to delivering safe and effective care services. It should also enable the effective management of populations and groups within the contract. This will include demonstrating effective population health management systems and competency in IT, data management and analysis, finance and risk management and actuarial skills. Relational The ability to engage and work with the public, patients and partners to define, deliver and measure health and care services to support the delivery of outcomes. Providers will be able to facilitate greater integration between service providers through effective leadership and governance. Through the delivery of the contract there will be positive engagement with commissioners, regulators and the third sector. Organisations will have the appropriate professional teams in place to deliver improved outcomes for patients and service users. Developmental An ongoing commitment and ability to deliver transformational change across the health and care economy that will improve services for patients and service users. These changes will realise improvements in quality and cost. Providers will work with service users to identify areas of change that will meet their needs and to influence others across the care economy to change and adapt. Plans will be in place to support the development of the professional workforce across organisations. Professional Care: The ability of the organisations to collectively have the appropriate capability and capacity to deliver co-ordinated care services that are safe and effective. 9

10 Framework: Capability Statements To demonstrate the three competencies, key capabilities need to be displayed. Eight capabilities have been identified and each of these can be broken down into a number of statements that relate to the core competencies. The eight capabilities are presented on the following pages along with their supporting statements. These statements provide further detail about the capabilities that providers will need to consider when thinking about managing and delivering an outcomes based contract for health and social care services. It should be possible to consider the maturity of an organisation to respond to the requirements of OBC using these statements and provide scores against both capabilities and competencies. Summary: A summary statement providing an overview of the capability References: How the statements relate to the core competencies: D = Developmental R = Relational T = Technical Statement with a (P) (e.g. T1 (P) ) relate to professional care Statements: Each capability includes a number of statements that provide further detail about the capabilities that providers should consider when thinking about managing and delivering an outcomes based contract. 10

11 1. Strategy and Vision To realise the potential benefits of outcome based commissioning providers will have a compelling vision and clear strategy for managing and delivering care across whole system pathways and/or for a defined patient group. The vision and strategy will be aligned to the needs of commissioners and set out a commitment to delivering clinical, patient and service user outcomes. The vision and strategy will underpin service integration and collaboration as it has been developed and is shared by organisations across the local health and care economy. Ref D1 R1 D2 D3 D4 R2 T1 T2 Statement We have a clear and compelling vision for the delivery of co-ordinated health and care services for the over 65s population in Croydon. This is supported by a commitment to the delivery of clinical and patient outcomes that add value. Our vision is shared across, and can be communicated by, all organisations involved in delivery of health and care services for the over 65s population in Croydon. We have a single strategy, aligned to the vision, setting out how health and care services will be managed, delivered and improved for the over 65s population in Croydon. It is clear, through the strategy, how each organisation will support its delivery. The organisations responsible for delivery have the appropriate capacity and capability at all levels to plan, manage and deliver their care services to realise the shared strategy and vision. Systems and processes across the organisations (e.g. performance management) are aligned to the delivery of the strategy and vision. All organisations are able to identify the role they play in supporting its delivery. Leaders both clinical, financial and managerial across all organisations understand and are able to articulate the strategy and vision. The strategy sets out how the organisation(s) will understand, plan and manage future health and care trends (for example future demand) relating to the over 65s population in Croydon. The strategy sets out how the organisation will address health and social care inequalities in the defined population. 11

12 2. Leadership and Governance There is an emphasis on excellent clinical and managerial leadership supported by robust governance that enables organisations across the system to continually develop and improve outcomes for patients/ service users. Leaders in organisations will have the ability to lead change across organisational boundaries that challenge traditional ways of working. They will also champion and role-model the culture of collaboration and integration. Governance structures will be appropriate and proportionate to enable effective delivery and shared decision-making. Ref R3 R4 D5 D6 R5 T3 T4 T5 (P) T6 Statement Leaders demonstrate and role-model a shared set of values and commitment to co-ordination across a number of organisations in order to support mutual trust and collaboration to improve quality and performance. Leaders from across organisations are aligned behind a shared vision and strategy to drive improvements in clinical and patient outcomes for the defined population. This vision spans traditional organisations and boundaries, focusing not just on treatment and support but also prevention. Leaders have the ability to influence and manage across organisational boundaries in order to manage and deliver transformational change across the whole health and care economy. Ability to determine the appropriate organisational form for the delivery of the defined outcomes. This would include the ability to draw on, and secure, capabilities from across a range of organisations to deliver patient-centred care. Leaders have a proven capability to lead and manage complex service redesign and transformation for the defined population across a health and social care economy. A clear governance structure is in place that allows for effective decision-making and management that breaks down the traditional silos that exist within health and care delivery. All organisations involved in the delivery of health and care services in scope of the contract are able to input to and inform decisions and, there is an appropriate balance of executive and non-executive input into decision making processes. Clear and embedded financial governance and accountability for delivering defined outcomes as well as from a cost perspective. Clear accountability and management for the delivery of safe and effective services across all organisations involved in delivering the contract. Conflicts of interest are managed effectively to support decision-making impacting all organisations involved in the delivery of the contract. 12

13 3. Processes Clearly understood management processes are in place which enable co-ordinated delivery and alignment across multiple organisations delivering health and care services. Processes will ensure that patients are involved in shaping the delivery of care services, organisations comply with regulatory requirements and there are effective systems to manage risk and support communication and learning. Ref R6 T7 (P) R7 D7 R8 (P) T8 (P) Statement There are processes in place across organisations to involve patients, carers and members of the public to shape and influence the development and delivery of health and care services for the over 65s population, as well as to support shared decision making. There is an effective system of controls for managing and evaluating clinical risk and patient safety across clinical and social pathways relevant for the defined population. These will include: Systems and processes for monitoring and acting on patient feedback Arrangements for monitoring quality and safety issues including safeguarding Systems to respond to issues and improve patient and service user care across pathway Ability to regularly share information and communicate across all organisations in order to improve collaboration and performance of the care economy. This will include: Processes to share learning in relation to quality and safety to all organisations A culture of open and honest communication Ability to demonstrate how consultation with organisations informs decision-making Robust project and change management systems and processes to support the delivery of complex, whole system, change to drive efficiencies and improve patient care. This is both within and across organisations. A clear and understood process to manage conflict and dispute resolution across organisations delivering health and care services within the contract. Process in place to support integration so that hand-offs across/between organisations in the management and delivery of health and care services are minimised whilst still supporting clear accountability along with defined roles and responsibilities. 13

14 4. Technology Technology is used to support the delivery of outcomes and ensure that care is centred around the patient. Integrated data systems will be in place that enable patient and performance information to be measured, monitored and shared across different provider organisations. These will be supported by robust information governance arrangements. Ref T9 T10 T11 T12 T13 D8 T14 (P) T15 Statement IT is integrated across all systems and organisations (primary, community, acute and social care) with information shared on a real-time basis. Information is visible to all, appropriate, health and care professionals regardless of setting. Systems are able to provide a single view of the patient and help avoid duplication of efforts and incompatible plans of care. This needs to enable users to read information, update data in whichever system is appropriate. For example; a single assessment and master data management to ensure consistency of information. Patients have the ability to access their care records if required. Reporting and risk stratification systems in place to identify high-risk patients and provide a joined up view of information relevant to a patient to the Health or Care professional, as well as supporting effective population health management. Robust and appropriate information governance arrangements are in place to ensure that; information can be shared across organisations and, patient consent can be recorded and used to provide access to records at the right time for Health / Social Care Workers. This will include a Nominated Caldicott Guardian and SIRO and supporting policies and procedures. Focus on continually improving systems and technology across organisations delivering services in order to support the improvement of services for patients within the defined population. Ability to capture information to support and demonstrate the delivery of outcomes for over 65 population and informs clinical decision making. Systems to support predictive analytics to support population health management. This will mean that individual and population needs can be modelled and planned for. 14

15 5. Performance Management Performance requirements and expectations are understood by all organisations involved in the delivery of the contract that reflect the agreed roles and accountabilities. Performance measurement, analysis, reporting and improvement processes across organisations and information is used to support ongoing improvements in the delivery of health and social care for the defined population. Ref R9 (P) R10 T16 T17 T18 T19 D9 T20 Statement Performance management processes are aligned to the delivery of outcomes for patients/service users and support innovation. Providers are incentivised accordingly. Performance management processes are aligned to the vision and strategy and supports collaboration across organisational boundaries on the basis of improved outcomes for the over 65 population. Performance expectations including goals, metrics and measurement tools - are aligned across organisations and each organisation is clear on their, and others, contribution to performance and, in particular, outcomes for patients and service users. Roles, KPIs, and management information are well defined and consistently applied across organisations. Single reporting arrangements in place across organisations to capture performance in line with contracts. Ability to capture and report evidence of performance against agreed outcomes in a timely manner, as well as financial and managerial matters and experiences of patients and service users. Use performance information to support decision-making to identify areas for improvement, innovation and redesign in order to achieve improved value for health and care services. Delivery and performance is supported by robust Business Intelligence (BI) that is routinely captured and reported. BI is used effectively to track performance against outcomes and to identify areas for improvement in the delivery of health and care services from organisational staff and patient perspectives. 15

16 6. Financial and Risk Management Appropriate financial and risk management controls are in place to identify and mange safety, reputational, demand and financial risks (including tax risk) and mitigate them through early action and identification. There is an ability to identify the cost base along a whole health and social care pathway and/or population group as well as share risk and systems to manage payment allocations to organisations involved in delivering the contract. Ref T21 T22 (P) T23 D10 R11 D11 R12 R13 (P) Statement A detailed understanding of the cost base across the whole health and social care pathway/population group to help identify efficiencies and reshape services within the agreed financial envelope. An ability to identify and reduce/balance unwarranted variation across a pathway or defined population which may indicate suboptimal performance. This will include the management of risks such as winter pressures. Clear and transparent processes to manage risk that enables risks to be identified at an early stage and be dealt with or shared collaboratively Ability to make informed and transparent investment and disinvestment decisions across the pathways/services within scope of contract. There should be certainty about how these decisions will be made and funded before, or at an early stage, of contract delivery. Effective financial and contract management processes to manage funding and payments to delivery partner organisations against agreed indicators and/or outcomes. This will mean that: Funding arrangements are fair, proportionate and do not cause undue financial risk for another organisation Clear contractual/legal documentation is in place Requirements of partner organisations have been taken into account There is a clear rationale for allocation of resources and market share There is agreement about how risks and savings will be shared across organisations Systems in place to identify future population and demographic changes that may impact on future contract values and manage financial envelope accordingly. A clear and robust approach to support the (re)allocation of resources and investment in the improvement of services irrespective of the current setting of care. Clear accountability across organisations delivering the contract regarding clinical safety and risk. This should be supported by effective governance arrangements and risk management processes. 16

17 7. People and Culture Organisations are able to identify, recruit and retain an appropriately skilled workforce across a number of organisation to deliver the high quality health and social care services. There is an ongoing commitment to workforce development and an ability to flex the workforce to meet changing demands. There is an emphasis on joint working that is supported by a culture of collaboration, quality and patient care. Ref R14 (P) D12 D13 D14 D15 R15 (P) R16 D16 Statement There is a shared and embedded culture, values and behaviours, across organisations delivery services for the over 65s population that reflects the needs of patients, carers and citizens. This can be evidenced by staff across all organisations. This is supported by the appropriate training, development and people policies. Systems are in place to continuously assess the organisational culture and take action for improvement where necessary. An ability to manage and support the workforce delivering the services during periods of significant change and transformation (both before and during the contract). This will include effective engagement to trade unions and staff and, the adherence to policies and requirements such as TUPE. There is a commitment and ability to flex and tailor the workforce across pathways and population groups to meet the changing needs of patients and service users as well as to respond to changes in demand. Staff are actively encouraged to work across traditional organisational boundaries. This includes organisations directly involved in contract delivery and also complimentary services/organisations who are involved in supporting the patient/service user group There is a clear organisational development strategy and plan that relates to all organisations delivering services in relation to the contract. This includes a patient centred workforce strategy that is inclusive of partner organisations and reflects plans for multi-agency and multi-disciplinary workforce development. There are also plans to support the wellbeing of staff. Organisations delivering services for over 65s have the appropriate capacity, skills and capabilities to deliver safe and effective services that support the delivery of patient outcomes. This is supported by a recruitment and retention plan to ensure that suitably qualified and experienced staff, will be sourced and retained, to deliver, safe and high quality health and care services. There is extensive evidence of widespread collaboration and informal and formal sharing across organisations, supported by effective systems and processes, all with the aim of supporting improved patient/ service user outcomes. Consistent and timely performance and development assessment across all staff that is aligned to the overarching strategy and vision, supporting high quality healthcare. 17

18 8. Sourcing and Collaboration Outcome based commissioning will require providers to be able to access resources from and collaborate with a range of organisations in order to deliver co-ordinated health and care services to a defined population group or across the agreed health and social care pathways. These relationships will need to be sourced, managed and supported by robust agreements. Innovation should run across organisations and their different skills should be drawn upon to inform decision-making. There should also be a commitment to ongoing development across all organisations and a focus on delivering patient/user-centred care through improved collaboration. Ref R17 (P) R18 D17 (P) R19 R20 D18 Statement Overall sourcing strategy supports the delivery of safe, effective and co-ordinated health and care services. All providers should have the appropriate capacity and capability at all levels to deliver care services and are agile in responding to changes to traditional delivery models. Capacity and capability to manage or collaborate with a range of organisations in the delivery of outcome based contracts. This will include an ongoing commitment to improvement in respect of contract and supplier management capabilities. Ability to promote innovation across organisations in order to drive improvements in performance and quality for health and care. This should include mechanisms to learn from each other, share good practice and collaborate to create new solutions to complex problems. Sourcing and management practices ensure variety to meet patient/service user, commissioner and contractual objectives. This includes the utilisation of, public, third and private sector organisations to address the holistic needs of the population group and local demographics. Sourcing strategy should allow, where possible, new market entrants but should not restrict supply and should support multiple providers within parts of the contract. This will facilitate and maintain appropriate levels of choice regarding treatment and setting of care. Ability to effectively collaborate with existing and new organisations to introduce further innovative service models to respond to changing needs within the population but also support improved outcomes for health and social care. 18

19 Framework Assessment

20 Framework Assessment: Summary To support organisations to consider their current position against the competencies and capabilities an assessment framework has been produced. Maturity Model The framework uses a Maturity Model as its basis which is a method to consider how well established an organisation is against a number of capabilities. Outcome based commissioning is a new approach so it is not expected that provider(s) will be leading in all areas. In some areas they will be emerging. This assessment allows them to recognise areas where there is the need to develop or transition, for example through creating partnerships or alliances with others. Scoring and Assessment The assessment supports organisations to consider their perceived current level of maturity against each of the statements, briefly describe why a rating has been selected and note any key evidence considered in reaching the conclusion on rating. The assessment is designed to be a self-assessment that can be completed in small groups or workshops so that information is drawn from a range of sources, perspectives and experiences within individual organisations. While there may be an intuitive sense of your organisations capability in each area, the most accurate self-assessment will come from in-depth discussion and tangible evidence. All of the capabilities listed are interconnected so it is important to get the whole picture where possible. Outputs and Next Steps The assessment will provide automated outputs to demonstrate performance against both competencies and capabilities. This will help inform development or transition plans. The completion of the assessment guide is not meant to be a one off exercise and repeating completion of it at appropriate time intervals will help track progress and development. 20

21 Appendix

22 Resources used to inform framework design A number of resources have been used to support the design of the framework. These include of examples of outcome based delivery in both the UK and internationally and insight from the private sector and other parts of the public sector. Insight has also been provided from the CCG, CSU and Local Authority. The Merlin Standard: Promoting Supply Chain Excellence ( Outcomes Matter: Effective Commissioning in Domiciliary Care - LGiU ( The NHS Standard Contract: A guide for clinical commissioners; NHS Standard Contracts team on behalf of the NHS Commissioning Board ( Grafton Group Clinical contracting considerations ( Accountable Care Organisations in the United States and England ( Accountable Care: Focusing accountability on the outcomes that matter ( Pennine MSK Partnership A case study of an Integrating Pathway Hub (IPH) Prime Contractor ( PwC Supplier Relationship Management ( Prime providers and capitated budgets: will they enable new models of care? ( Delivering integrated care: a prime contractor model ( Pennine MSK: A whole system approach ( Clinical and service integration: the route to improved outcomes ( Monitor: Risk Assessment Framework ( Monitor: Enablers and barriers to integrated care and implications ( Insight from NHS Cambridgeshire and Peterborough CCG Integrated Older People s Pathway & Adult Community Services Procurement, Bedfordshire MSK and Oxford CCG Outcome Based Commissioning Business Case. 22

23 Framework: Capabilities summary 1. Strategy and vision: To realise the potential benefits of outcome based commissioning providers will have a compelling vision and clear strategy for managing and delivering care across whole system pathways and/or for a defined patient group. The vision and strategy will be aligned to the needs of commissioners and set out a commitment to delivering clinical, patient and service user outcomes. The vision and strategy will underpin service integration and collaboration as it has been developed and is shared by organisations across the local health and care economy. 2. Leadership & Governance: There is an emphasis on excellent clinical and managerial leadership supported by robust governance that enables organisations across the system to continually develop and improve outcomes for patients/ service users. Leaders in organisations will have the ability to lead change across organisational boundaries that challenge traditional ways of working. They will also champion and role-model the culture of collaboration and integration. Governance structures will be appropriate and proportionate to enable effective delivery and shared decision-making. 3. Processes: Clearly understood management processes are in place which enable co-ordinated delivery and alignment across multiple organisations delivering health and care services. Processes will ensure that patients are involved in shaping the delivery of care services, organisations comply with regulatory requirements and there are effective systems to manage risk and support communication and learning. 4. Technology: Technology is used to support the delivery of outcomes and ensure that care is centred around the patient. Integrated data systems will be in place that enable patient and performance information to be measured, monitored and shared across different provider organisations. These will be supported by robust information governance arrangements. 5. Performance Management: Performance requirements and expectations are understood by all organisations involved in the delivery of the contract that reflect the agreed roles and accountabilities. Performance measurement, analysis, reporting and improvement processes across organisations and information is used to support ongoing improvements in the delivery of health and social care for the defined population. 6. Financial and Risk Management: Appropriate financial and risk management controls are in place to identify and mange safety, reputational, demand and financial risks (including tax risk) and mitigate them through early action and identification. There is an ability to identify the cost base along a whole health and social care pathway and/or population group as well as share risk and systems to manage payment allocations to organisations involved in delivering the contract. 7. People and Culture: Organisations are able to identify, recruit and retain an appropriately skilled workforce across a number of organisation to deliver the high quality health and social care services. There is an ongoing commitment to workforce development and an ability to flex the workforce to meet changing demands. There is an emphasis on joint working that is supported by a culture of collaboration, quality and patient care. 8. Sourcing and Collaboration: Outcome based commissioning will require providers to be able to access resources from and collaborate with a range of organisations in order to deliver coordinated health and care services to a defined population group or across the agreed health and social care pathways. These relationships will need to be sourced, managed and supported by robust agreements. Innovation should run across organisations and their different skills should be drawn upon to inform decisionmaking. There should also be a commitment to ongoing development across all organisations and a focus on delivering patient/user-centred care through improved collaboration. 23