Commissioning for Populations

Report
Populations or Pathways?
Liane Langdon
Anthony Lawton
NHS Leeds North CCG
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Local Strategic Context –
Leeds Joint Health and Well Being Strategy
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What did we do with Commissioning
for Value?
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Use CFV but also locally what fits –
the life expectancy gap by cause of death
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So Summary: Overarching messages
for Leeds
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Public health focus on prevention; specifically smoking
prevalence (Leeds South & East and Leeds West) smoking
cessation (All) and Obesity (Leeds South & East)
Significant benefit to patients if improvement to Primary
Care management indicators were made (All)
High emergency admissions for CVD (Leeds South & East),
costs (Leeds North and Leeds South & East) and lengths of
stay (All)
High costs for CHD emergency admissions (Leeds North
and Leeds South & East) and high costs for CHD elective
admissions (Leeds South & East)
High emergency admissions for Heart Failure and Stroke
(Leeds South & East and Leeds West)
High costs for Angiography procedures (All), CABG
procedures (All) and Angioplasty procedures (Leeds West)
High lengths of stay for Angiography procedures (Leeds
West)
Summary on a page
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8
Actions …………..
• Public Health – challenge to jointly re look at
commissioning of healthy living services key priority for
the Council.
• Primary care – variation target work with key practices
and embed into engagement schemes in each CCG
• Whole pathway – flow and variation – LIQH.
• CCG commissioning – using packs as part of
prioritisation framework
• Transformation work streams -Acute – elective care
value approach; Integrated Care – Pathways work.
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The LIQH approach
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LIQH – focussed areas
CVD
• improving the management of chest pain;
• optimise outcomes and quality of care for people requiring
interventions/ treatment for suspected/confirmed
arrhythmia and to prevent inappropriate use of secondary
services.
COPD
• support people with COPD to manage their own condition
and to reduce the likelihood and impact of exacerbations;
• reduction in variation of approach to COPD patients in
crisis;
• Improving the early and accurate diagnosis of COPD whilst
improving patient experience.
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Pathways
• So, for pathways
– The data gives us some clear indication of
pathways to consider
– We have established clear programmes of work
• But, is this enough?
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Populations
• Great for quality improvement
• But – is this enough for transformation?
• What about complex populations?
– CfV tells us where the challenges are
– But we know that with populations, pathway
approaches are not always enough
– What can CfV do to inform work with the frail
elderly?
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we’re better
Liberating CfV for Populations
• What we did next:
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Used the CfV intelligence
Used part of the £5 per head for primary care (£2.36)
Identified our target population – frail elderly 2%
Applied Outcomes Based Accountability to liberate
practices to use CfV knowledge creatively to tackle an
issue requiring transformation, not quality
improvement
– Look for contribution not attribution – asked practices
to work in localities to give something a go
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we’re better
Overview of OBA
• Outcome Based Accountability™ was first
developed in the early 1990s by Mark
Friedman
• Principles:
SIMPLE
COMMON SENSE
PLAIN LANGUAGE
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Definitions
OUTCOME
A condition of well-being for adults, children, families, communities
i.e. Being Healthy, Staying Safe, Safe Communities, Clean Environment
INDICATOR
A measure which helps to quantify the achievement of the outcome.
i.e. Rate of diagnosis of Dementia in Primary Care, Rate of teenage
pregnancies
PERFORMANCE MEASURE
A measure of how well a program, service is working
Based on the 3 following questions:
• How did we do?
• How well did we do it?
• Is anyone better off?
ENDS
MEANS
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Leaking Roof
Not OK
Experience:
? Fixed
Measure:
Turning the curve
Story behind the baseline (causes):
Partners:
What Works:
Action Plan:
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What now?
• Supported practices in locality groupings to
identify meaningful local measures relating to
how they are contributing to the issues
identified within CfV
• Practices are all enhancing community nursing
– but in different ways
• Measure and look for learning and impact –
and share
• Worry about contribution, not attribution
• Do more of whatever works!
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Questions

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