2014/15 National TariffPayment System &

Draft Guidance on MentalHealth Currencies and

Payment

1

The Challenge for 2014/15

• Increasing Caseload and Casemix awareness• Agreeing & Implementing Quality and Outcomes• Supporting Care Pathways and Interventions • Supporting Engagement with Service Users• Develop a robust long term payment mechanism• Transactional Simplicity• Avoid de-stabilising health economies

2

Monitor Mandatory requirements to be embedded in contracts

•Use the 21 Care Clusters as contract currency•Cluster Reviews to be completed within maximum period in the Mental Health Clustering Tool Booklet•MHMDS data based on data from MH Clustering Tool•Option for moving away from block contracts using caseload based approach and thresholds and caps•Quality Outcomes to be agreed for each Cluster

3

Basic Payment Mechanism

•Recommend use of Cluster day as the basis for contracting•Local Cluster prices may be analysed by setting e.g. Admitted,

Non – admitted and Initial Assessment•Active Service User caseload can be analysed by Cluster and updated on a quarterly basis•Agree any data cleansing methodology of the clinical caseload within the memorandum of understanding•Compliance with Cluster Review Periods for Active Service Users on the caseload – to be used as a Quality Indicator metric

4

Risk Management

• Memorandum of understanding based on last year’s model

• Before moving to cost and volume approach commissioners must be assured that the thresholds set to manage financial risks reflect ongoing contract developments

• The Memorandum of understanding should :

- Include methodology for any Data Quality improvement initiative

- Cluster information should be used to inform service change

not impose service change

5

Quality and Outcomes

• Cluster Review Periods should be within the maximum review periods specified in the Clustering Booklet and included in the national contract.

• Compliance with the Cluster Review Period should be a Quality Indicator metric.

• Suggestions for use of wider quality and outcome metrics linked to– CQUIN incentives (PREM, PROM, Clinical indicators)

6

Right Balance

• The underpinning currency has been simplified• We MUST ensure there is real emphasis given to the

Quality and Outcomes agenda.• Need incentives and penalties• CQUINs a tool to support this• A focus for local agreement

7

Right Pace

• Incentives and penalties need to be used cautiously• we don’t yet know what good is for a lot of things• Improvement trajectories may be more helpful than

absolute performance in the first instance• MHMDS information will be available via HSCIC • National standards, requirements and expectations will

then be possible in subsequent years

8

Right Content• 10 Data Quality Indicator metrics available via MHMDS

that give an insight into an organisation’s performance around clustering.

• An additional 8 Data Quality Indicator metrics available for potential local / national use

• Local agreement must be reached on which metrics to focus on.

• These should be jointly reviewed each quarter.

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Next stages for national development

• Set out longer term direction of travel – Days /Periods• Key issues to resolve

– Developing and using the outcome metrics in contracting

– Deeper understanding of impact of variation in provider landscape

– Initial Assessment– Fit with wider integration agenda

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Where are We Now?• We now have better information than we have ever had• Transparency in the system challenges us to change• The focus has to be on outcomes - this is our main challenge going

forward• Providers and Commissioners jointly need to take hold of the

information agenda• Jointly managing risk is critical• We must understand and be assured of underlying data before

using it for change• Opportunities for innovation and seizing the agenda

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