www.springfieldconsultancy.co.uk business case and applied economic evaluation mike firn – health...

www.springfieldconsultancy.co.uk

business case and applied economic evaluation

Mike Firn – Health care Consultant

http://www.springfuieldconsultancy.co.uk/



Overview

• Brief economic imperative• Pathway/ blended model of Skype and

conventional • Methods • Costs and benefits in monetary terms of the

blended model • Who benefits financially?• Commissioning implications?• Conclusions



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Cliché of the burning platform?

• Total number of people with diabetes in Newham is rising by >800 each year.

• Prevalence of Diabetes in Newham is high at 5.7%

• Limited patient engagement and self-management

• Yet Hba1c levels continue to improve despite the challenges



unscheduled FU appointment(patient initiated)Follow up tariff Medical (grade)

Consultant scheduled FU appointmentFollow up tariff or block Medical (grade)Assume booking to skype or F2F requires equivalent resource or cost

Consultant specialist review People with

Diabetes – uncomplicated GP care

People with Diabetes requiring

specialist input from community diabetes nursing/ podiatry

and or dietitian

New appointment Face 2 Face (requires physical exam usually)New appt tariff.MedicalTime takenCost DNA rate / referral to FU rate or equivalent

Patient choice and access

F2F appointment in OPC -health centreTime takenCostDNA

Skype appointment Time taken Cost DNA

Community Nursing Scheduled FU appointmentFollow up tariff or block Diabetes Nurse (grade)Assume booking to skype or F2F requires equivalentresource and cost

Patient choice and access

F2F appointment in OPC -health centreTime takenCost DNA

Skype appointment Time taken CostDNA

Podiatry F2F appointment in OPC -health centreNo skype option

Dietitian F2F appointment in OPC -health centreNo skype option

Skype appointment Time taken Cost

unscheduled FU appointment (patient initiated)Follow up tariff nurse (grade)

Skype appointment Time taken Cost

Study question: quantify the comparative costs and consequences between F2F and Skype appointments

Super six at Newham covers:•Inpatient/Complex T2D•Antenatal•Diabetic feet•Renal disease•Type 1 and pumps•Children and Young Adults (includes some young T2D)

Presenting with

super six?Need for care beyond GP only

NO

YES

Simplified care pathway


Study question and methods• quantify the comparative costs and consequences

between conventional F2F and Skype appointments

• Mixed methods- pragmatic and applied; to promote adoption

• Light green and dark green $ distinctions (IHI)$ “when is a saving not a saving”

• National and local costings £ unit costs medical consultant hour £101, DSN £51, receptionist £21.

HRG 307 diabetic medicine New £225, FU F2F £101(national so local + MFF), non face to face £26.




Headline findings- productivity

Light green or dark green, or even more complicated ?




Headline Findings- DNA




Headline findings-Diabetes related complications

Empirically linked to engagement and treatment adherence. Skype confers advantages for engagement and adherence through reduced DNAs for scheduled appointments but also the facility for unscheduled appointments• Sensitivity analysis on avoided A&E and DKA episodes

Complication event Low n (£ saving) Base n (£ saving) High n (£ saving)

A&E attendance n 5 (£610) 10 (£1,220) 20 (£2,440)

DKA admission n 5 (£8500) 10 (17,000) 20 (£34,000)

Total saving to CCG £9,110 £18,220 £36,440




Other avoidable complications• Diabetes is estimated to have cost the UK £9.8 billion in direct costs in 2010/2011,

this equates to approximately ten per cent of the total health resource expenditure. It is estimated that 80 per cent of these costs are incurred in treating potentially avoidable complications.

• Premature mortality with over 22,000 additional deaths each year. • Doubles the risk of cardiovascular disease (heart attacks, heart failure, angina,

strokes). • Most common reason for end stage kidney disease and the most common cause

of blindness in people of working age. • Up to 100 people a week have a limb amputated as a result of diabetes, and in

many cases this is avoidable. • Nearly 1 in 5 people with diabetes have clinical depression and for those with

anxiety and/or depression health care costs increase by around 50%.• (Source Action for Diabetes-NHS England in 2014)




Headline findings- patient pocket

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Set up costs versus savings

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Commissioning considerations-Incentive example

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Virtual clinic example from orthopaedics. Incentivised by agreement of a CQUIN incentive payment in 2015-16. The face to face tariff of £72 has also been retained pro tem. Agreement of a virtual tariff is deferred until fuller evaluation of benefits in a mature service has been established.




Commissioning considerations-disincentive examples

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1. Block contract (DSNs)2. Commissioner determines that skype calls are

not eligible for the standard PbR tariff payment and would therefore have to be charged as non face to face.Local price agreed for non face to face appointments £26. Negotiations on a virtual / online/ skype tariff delayed by poor commissioner engagement




Conclusion

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In most contexts project set up and ‘retooling’ costs can be recovered in year 1 and a return on investment surplus in subsequent years. This is over and above the benefits from keeping up with rising demand.Commissioning contract arrangements complicate the business case and make some of these financial gains opaque to clinicians



www.springfieldconsultancy.co.uk business case and applied economic evaluation mike firn – health...

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