Alcohol Treatment within Payment by Results for Mental Health. Overview and journey to date. Don Lavoie DH Alcohol Policy Team

Transcription

1 Alcohol Treatment within Payment by Results for Mental Health Overview and journey to date Don Lavoie DH Alcohol Policy Team

2 CUSTOMER Cabinet Office Commissioning on the basis of results Commissioner need a clear framework for deciding when PbR is (and is not) appropriate 1 Individual Personal choice about who provides service & satisfaction with that provider Local LAs enable collective decision- making, devolved to the lowest possible level (i.e. Street level) National Central government as an independent customer separate from national delivery bodies Significant amount of current public service spend sits here. but should, when conditions are appropriate, move to this space The Government wants as maximum choice to sit with the individual, however this will not always be possible commissioning on behalf of individuals will still be needed Historical budgets Activity based Output based Outcome based Incrementally adjustmentsusually based on potential need & / or historical costs of the services for an area or from a provider Determined by complex funding formulae (including a unit price), or a target unit price that is regularly updated based on market-tested prices Payment for results: outputs, where a price is paid for an output and reflects a significant transfer of the risk of success to the supplier Payment by results: better outcomes, where a supplier takes on a broadly defined outcome, & is paid by that overall outcome, rather than by specific outputs Sources: 1- Adapted from: KPMG (2010) Payment for Success BASIS FOR PAYMENTS RESTRICTED 2

3 PbR Models so far Historic Block Contracts Activity based PbR Outcome based PbR How NHS hospital were funded Historical costs Local NHS family & budgets How NHS Acute Trusts funded today Health Resource Groups (HRGs) Tariffs PROMs Transfers risk to providers Experimental Recovery PbR Prisons Work Programme Immigration 3

4 History of PbR in the NHS PbR introduced into NHS acute sector. A move away from sweeping block contracts towards payment for activity delivered Mental Health started work on PbR but restricted work to main-stream adult mental health services 2010 programme began to include alcohol treatment within PbR for Mental Health (most NHS Mental Health Trusts deliver alcohol treatment along with voluntary sector agencies mixed economy) commissioning of alcohol treatment services will transfer to LAs the same time PbR is ready to introduce 4

5 Mental Health Clusters Working aged Adults and Older People with Mental Health Problems A Non - Psychotic B Psychotic C Organic a Mild/ Mod/ Severe b Very Severe & Complex Blank place marker a First Episode b On-going or recurrent c Psychotic crisis d Very Severe Engageme nt a Cognitive Impairment

6 Alcohol Treatment PbR development process DH convened a Steering Group (from October 2010) Royal Colleges Professional bodies Membership organisations and other government departments DH advised by an Expert Group (from November 2010) Psychiatrists Nurses Commissioners Data managers; and Senior managers from services, NHS Voluntary sector 6

7 Alcohol Treatment PbR development process Pilot areas invited to test products (invited July 2011) Middlesbrough Nottingham Rotherham; and Wakefield All progress reported to Mental Health PbR Product Review Group 7

8 Products needed for PbR 1. CLUSTERING TOOL A method to assign individuals into needs based clusters (= to Health Resource Groups) 2. PACKAGES OF CARE - Needs-based packages of care that are evidence based and cost effective 3. OUTCOME MEASURES Assess the progress and effectiveness of treatment 4. MINIMUM DATA SET - Captures Assessment / Clusters Treatment journey Outcomes 5. COST REPORTING TOOLS - Capture costs for treating each cluster to inform local tariff setting 8

9 4 Alcohol Clusters Alcohol Harm Clusters Dependence Health Needs HoNOS / SARN scales Social Needs HoNOS / SARN scales 1. Harmful & Mild Dependence 2. Moderate Dependence 3. Severe Dependence 4. Moderate & Severe + Complex Need AUDIT 16+ SADQ <15 Units/day <15 AUDIT 20+ SADQ Units/day >15 AUDIT 20+ SADQ >30 Units/day >30 AUDIT 20+ SADQ >15 Units/day >15 2. Non-accidental selfinjury 3. Problem-drinking or drug-taking 4. Cognitive problems 5. Physical Illness 6. Hallucinations and delusions 7. Depressed Mood 8. Other Symptoms A. Agitated behaviour (historical) B. Repeat self-harm (historical) 1. Aggressive behaviour 9. Relationships 10. Activities of Daily Living 11. Living Conditions 12. Occupation and Activities 13. Strong unreasonable beliefs C. Safeguarding children D. Engagement E. Vulnerability 9

10 Clustering Tool Cluster 1 10

11 Treatment modalities Treatment Harmful & Mild Depend Moderate Dependence Severe Dependence Moderate & Severe + complex Inpatient Detox Outpatient Detox Residential Rehab Day Treatment Psychosocial Intervention Brief Treatment Brief Advice +++ Other (key work, care manage)

12 Packages of Care NICE guidance defines these packages ( NICE - STOP looking at care - service by service Detox, Residential Rehab, Day Treatment; etc NICE - START looking at packages / stages of care: Assessment & engagement Care planning & case management Withdrawal management Addressing physical and psychiatric co-morbidity Psychosocial interventions Pharmacotherapy Recovery, aftercare & reintegration 12

13 Outcome monitoring Outcome monitoring is important in assessing how treatment for alcohol misuse is progressing The main aim of outcome evaluation should be to assess whether there has been a change in the targeted behaviour following treatment Outcome monitoring aids in deciding whether treatment should: be continued, or a change of the care plan is needed There are three important areas of outcome monitoring; 1. deciding what outcome to measure, 2. how to measure it (the appropriate tools), and 3. when to measure outcome. Routine outcome monitoring (including feedback to staff and patients) has been shown to be effective in improving outcomes Routine session by session measurement provides a more accurate assessment of overall patient outcomes NICE Guidance 13

14 Outcome monitoring There is no consensus in the alcohol treatment field as to which tool is best to use There are a number of existing tools that may be suitable including: Comprehensive Drinker Profile Addiction Severity Index MAP RESULT Christo Inventory for Substance Misuse Services (CISS) TOP The Alcohol Star ATOM HoNOS APQ AUDIT 14

15 Outcome monitoring Alcohol Treatment PbR Pilots tested: AUDIT O (Outcome) 3 month recall period Alcohol TOP Removed harm reduction section crime section Kept Alcohol & drug use Health and social functioning Performance of both still being assessed 15

16 Reporting costs NHS Mental Health Trusts now reporting costs by cluster the cost of treating an individual in the cluster Alcohol Treatment PbR Pilots investigating ways to report costs by cluster Methods developed by pilots will be made available for others to use 16

17 Alcohol PbR Progress Month / Year September 2012 Action Complete Analysis of Pilot Clustering Data October 2012 November 2012 until??? Discuss clustering tool Steering Group Pilots Expert Group Clustering tools refined??? Data analysis and tools refined Outcome measures Reporting costs 17

18 Usual PbR Next Steps Action Year 1 Currencies (clusters) announced Year 2 Year 3 Currencies available for use Patients assigned a cluster Report reference costs based on clusters Year 4 Clusters inform local indicative tariffs 18

19 Alcohol Treatment PbR offers opportunities More productive discussions between commissioners and providers Tools to facilitate bench-marking (for both providers and commissioners) Evidence based packages of care that encourage greater investment in proven interventions Tools leading to better care and better outcomes for service users 19