Payment by Results for Drug Recovery Pilot

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1 Payment by Results for Drug Recovery Pilot Enfield s Model Andrew Thomson DAAT Strategy Manager Striving for excellence

2 Structure Introduction Context Enfield s Approach Financial Model Ambitions & Challenges Creating a System for Success

3 Context Local Area Stark health inequalities and a significant gap in life expectancy between the most deprived and affluent wards Supporting recovery and reintegration is imperative as 78% of our substance misusers reside in wards where life expectancy is lowest Improved health and well-being is key to reducing the risk of relapse

4 Enfield s Approach Prime Provider model with separate Integrated Offender Management (IOM) provider commissioned under exactly the same Framework Four outcome domains building on National outcomes which includes an additional domain* and a further 17 measures for the Health and Well-being outcome: - Improved Health & Well-being - Free from Dependency - Reduced Offending (Cohort measure) - Employment, Training and Education*

5 Financial Model for PbR (1) Successful treatment completion rates used to set outcome targets, weightings and tariffs 5 cohort groups which have different achievement levels across each outcome domain: - Opiate users - Crack users - Prescribed for other drug and alcohol users - Other drug users - Alcohol users

6 Financial Model for PbR (2) Successful completion treatment rates for 2010/11: Opiate Users 6.6% Non-Opiate 39.8% All Drug 14.8% Model assumes 20% uplift in the number of people achieving successful treatment outcomes across the four domains

7 Financial Model for PbR (3) Value of treatment system will remain the same but the Prime Provider will have more control of other traditionally commissioned DAAT services Payment by outcome with some elements rewarded for activity % of tariff achieved depends on performance against outcome measures 27% of tariff attached to Discharged Free of Drugs of Dependence (available after 12 months)

8

9 How do the cohorts differ? Our Model recognises that: - Cost of treatment is higher for some cohorts - Opportunity for recovery varies between the cohorts 2 different annual tariffs in total for the Prime Provider but each cohort has different successful treatment completion rates. Cohort Annual Treatment Tariff Opiates Crack 3, Other prescribed drugs/alcohol Other drugs not prescribed for Alcohol 1,026.27

10 Flexibility within the model Crime outcome is based on cohort performance For the Crime Reduction domain: - Minimum payment to be made for achievement of the baseline - Deduction of 1000 per offence if crime baseline not achieved - Providers will be rewarded 1000 for every additional offence saved compared to baseline, up to 5% of combined contractual value

11 Enfield Drug Treatment Journey Interventions Recovery Outcomes Patient ACRT Triage and Assessment Tariff setting Care management TOPs completion Careplan Reviews Confirming Outcomes Authorising Payments Family intervention assessment Motivational interviewing Family interventions Offending behaviour interventions In-patient or community based detoxification Needle Exchange Alternative therapies Drop in, advice and information Other Structured Psychosocial Interventions Integrated Offender Management Structured Counselling Structured group work programmes Residential rehabilitation Medically assisted stabilisation and detoxification Pre-rehab preparation groups Reduced cardiovascular disease Harm minimisation Improved health outcomes Reduced offending behaviour Reduced high risk sexual behaviour Infectious disease prevention Free from drugs of dependence Improved Mental Health and wellbeing Reduced cigarette smoking Reduced hospital admissions Improved child safety and family wellbeing Reduced injecting behaviour Access to safe and secure housing Reduced drug & alcohol related deaths Reintegration Activities Self help groups Social events College Training Education Volunteering Employment Peer mentoring Housing

12 Enfield DAAT Data Flow Providers input data into Theseus ACRT verifies outcomes Automatic invoice creation Payment release Submission to Home Office/DIRWeb Re-offending measure ACRT assess service users to identify Careplan, tariffs and outcomes Submission to NDTMS via DAMS

13 Performance and Payment Monitoring

14 Summary of Ambitions 17 additional health and well-being measures above the National Outcome Framework 55% increase in the number of drug users in IOM treatment against the 10/11 baseline 20% uplift in successful treatment completions against the 10/11 baseline

15 Market Sustainability Seeking to keep a diverse and competitive market place of good high quality providers Committed to encouraging providers to embrace PbR and supporting other DAATs with developing PbR Utilised accounting solutions to afford provider stability to embrace PbR Claw back clause to correct under-performance

16 Creating a System for Success Very strong local partnership with senior stakeholder and service user strategic commitment to make PbR a success Defined outcomes consistent with the National Drugs Strategy 2010 Transparency through a single database across all commissioned providers Experienced & skilled Assessment and Care Review Team Focus of maximising outcome opportunities to really embrace recovery and reintegration

17 Discussion

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