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Conference 2015
Looking ahead for specialised servicesk
#shca2015
Conference Chair: Alastair McLellan - Editor, HSJ
@theSHCA
#shca2015
Accelerated Access Review
Specialised Healthcare Alliance
14 July 2015
The review’s Terms of Reference highlight how it will:
• Address innovative medicines, devices and diagnostics
equally (digital products also a focus);
• Explore how to accelerate use of data and evidence to drive
development, commissioning and decommissioning; and,
• Recognise the importance of patient voice and patient trust.
Given the funding landscape, cost-effectiveness and affordability
will be front and centre of recommendations.
The review will conclude by the end of 2015, with an interim report in the late summer.
Our approach will allow a wide range of stakeholders an opportunity to contribute views on the future scheme
8
Currently:
• Can take 10-15 years to get a new product from discovery into the system and can cost over £1billion;
• No standard pathway for new medtech or digital products;
• Increasing public debate around access to these products (e.g. Cancer Drugs Fund, Hep C).
The review will not:
• Alter the 2014 Pharmaceutical
Price Regulation Scheme
(ends 2019);
• Overlook existing statutory
responsibilities of NHS bodies;
• Overlook relevant European
legislation.
Trials (from proof of concept) Regulation Reimbursement Adoption/diffusion
The review will span the development and uptake of medicines, medtech and digital products, through:
The review aims to accelerate access to innovative drugs, devices and
diagnostics for NHS patients
The review’s recommendations will be designed to realise a number of
benefits:
• Good for patients
• Good for the NHS
• Good for research organisations and charities
• Good for business
• Good for this country
The review will build on existing initiatives in the early access landscape, forging a
coherent runway through these to benefit patients, innovators and the healthcare system
1. Ebola response2. Dementia
- Early Access to Medicines Scheme- STAMP expert group- Triennial review (via DH)
Dowling Review
- Office for market access- Innovative funding models- Triennial review (via DH)
- Cancer Taskforce- Test beds- Road map to innovation support- New models of care
Review of specialised tariff
Adopt and Diffuse – barriers to innovation in the NHS
- Social contract- Real world evidence
Medicines Access in Europe
We have an External Advisory Group to provide ongoing challenge
The External Advisory Group’s role is to:
• Generate recommendations to accelerate access (recognising both cost-
effectiveness and affordability);
• Champion the review among stakeholders;
• Bring in wider expertise and generate buy-in for recommendations;
• Bring expertise around innovation in the pipeline, including digital; and,
• Champion individual workstreams (where required).
• Prof Graham Lord
• Eric Low
• Prof Sir Alex Markham
• Dr Keith McNeil
• Hilary Newiss
• Kevin Moore
• Prof Jeremy Farrar
• Prof Sir David Fish
• Noel Gordon
• John Jeans
• Richard Murray
• Rob Webster
• Prof Richard Barker
• Kate Bingham
• Chris Brinsmead
• Prof Sir John Burn
• Dr Mike Capaldi
• Dr Stuart Dollow
• Alastair Kent
• Dr Jonathan Knowles
• Dr Harpal Kumar
• Dr Jeremy Levin
• Prof David Lomas
• Raj Long
Chair: Sir John Bell
Affordable
national funding
models to drive
innovation
Accelerated
development
pathways
1
Medicines: to include developing/refining future-proofed pathways for genomics and precision medicines (with companion
diagnostics).
Medical technologies: to include developing/refining future-proofed pathways for standalone diagnostics.
a
Articulating need,
priorities and
principles for
innovation
Supporting
affordable uptake
and adoption
2 3 4
Patient and user engagement
Digital health: to include designing pathways tailored specifically towards next generation digital products and addressing
particular issues e.g. designing technology risk stratification principles and acknowledging data interoperability requirements
b
c
Three end to end pathways:
Addressed via four workstreams, each with an external champion:
Underpinned by patient and user engagement:
Richard Barker,
CASMI
Stuart Dollow,
Verrmilion
Richard Murray,
King’s Fund
Rob Webster, NHS
Confed
Hilary Newiss,
National Voices
12*for further details, see Annex A
The review will look at the end-to-end pathways for innovative medicines,
medtech and digital health products
We want people to get involved.
• We want to involve as many people and groups as possible so we can explore
the answers together.
• Our website is now live:
https://www.gov.uk/government/organisations/accelerated-access-review
• From tomorrow everyone will be able view the key issues we are considering and
provide their views.
• You will also be able to keep in touch with the review by signing up for email
updates or following the review on twitter at @AccelAccess.
13
www.england.nhs.uk
Integration for
specialised services
How will collaboration between
CCGs and NHS England square
the circle of better integration for
patients without compromising
national service specifications
and treatment policies?
Dr Nick Harding OBE MB ChB BSc FRCGP MFMLM HonMFPH DRCOG
DOccMed PGDIP(Cardiology)
Co chair Specialisedcommissioning oversight group
@nickjharding
www.england.nhs.uk
www.england.nhs.uk
5 guiding principles set out
To improve pathway integrity for patients• To help ensure that specialised care is not commissioned independently from the rest
To enable better allocation or investment decisions• Giving CCGs and their partners the ability to invest in upstream or more effective
services
To move towards population accountability • To lay the groundwork for ‘place based’ or population budgets and clearer
accountability
To improve financial incentives over the longer term• Avoiding specialised care where appropriate and reducing unwarranted variation
To focus NHS England on services that are truly specialised• Helping improve focus and the quality of specialised commissioning
1
2
3
4
5
What do patients need?
They tell us that they would like:
• Access – healthcare support easy to find when they need it
• Care About Me and My World
• Help to help themselves - an understanding of how they can make positive changes
• Help with what choices they have
• One service around them
Patients
What do commissioners want ?
• Good quality safe care
• A culture of continuous improvement
• Health and care system working together
• Better integration – primary, secondary, social, community
• Unblock and release resources - patients moving through hospitals, effective discharge people into home environment
Clinicians
Managers and support
What does the NHS need?
Clinicians supported in their role – training and development,
flexible hours, developing specialisms and technology enabling
efficient working
Patients and populations – proactively managed and able to
help themselves more
New style of primary care fit for 21st century and today’s society,
managing access and demand more appropriately
www.england.nhs.uk
Five Year Forward View
For specialised services where quality and patient volumes are strongly related, such as trauma, stroke and surgery, the NHS will move towards consolidated centres of excellence.
By summer 2015, NHS England will initiate a first round of service reviews national, regional and locally.
2015/16 will involve current providers preparing to implement the new standards for congenital heart disease services for children and adults, for example through new collaborations.
• Specialised commissioning working with providers and other local commissioners to make demonstrable progress in improving the system of care and reducing the reliance on inpatient care for this group of service users: ensuring inpatients are supported back into the community Inc deliver of the measure and recommendations in ‘Winterbourne view- time for change’
www.england.nhs.uk
Five Year Forward View
1. Rebalancing Primary Care– budgets, investment, focus
2. New partnerships - local communities, local authorities and employers
3. New models - breakdown barriers of how care is provided, dissolving traditional boundaries between primary, community, hospital and social care
4. Control over quality and spend e.g. agencies, seven day
5. Local focus – what is right for Birmingham may not be right for Bournemouth
www.england.nhs.uk
Collaborative Commissioning Guidance
CCGs and specialised commissioning hubs will come together to
establish collaborative commissioning arrangements to design and
develop commissioning pathways, ensuring they are grounded in
local need.
From 1 April 2015, one collaborative commissioning oversight group
will be established in each specialised commissioning hub.
Oversight groups will come together priority setting and the design
and delivery of transformational change across whole pathways.
We see 2015/16 as a development year in which NHS England and
CCGs can build upon and strengthen collaborative arrangements.
www.england.nhs.uk
Summary of commissioning models
Between 65-95 services
•all the highly specialised services + some that require national-level planning
•establish a single, enhanced central structure to commission these services in England.
Vast majority of other services on the prescribed services list
•establish co-commissioning joint committees between NHSE and CCGs
•NHSE continues to retain statutory & budgetary responsibility to minimise risk in the
system. CCG participation voluntary
•each committee given ‘notional budget’ (based on spend for relevant population)
•any overspend would continue to be NHS England’s responsibility
•benefit-share scheme – Participating CCGs would receive % of any underspend on
specialised
2 services
•specialised wheelchair services, and outpatient neurology
•NHSE supporting potential transfer of commissioning responsibility to sit with CCGs
•16/17 bariatric surgery
MODEL 1: NHSE
nationally commission
MODEL 2: NHSE
collaborative
commissioning, working
with CCGs
MODEL 3: Devolved
commissioning
responsibility to CCGs
www.england.nhs.uk
2015/16 Statutory Responsibility
MODEL 1: NHSE
national commissioning
MODEL 2: NHSE
collaborative
commissioning, working
with CCGs
MODEL 3: CCG led
commissioning
Services commissioned centrally for whole of country
Services commissioned by NHSE – at the 10 NHS Area
team hub level – working in collaboration with CCGs in
those areas
Services commissioned by CCGs for their local health
economy, or in collaboration with other CCGs to cover
wider geography
NH
SE
le
ga
lly a
nd
fin
an
cia
lly r
es
po
nsib
leC
CG
le
ga
lly a
nd
fin
an
cia
lly r
es
po
nsib
le
www.england.nhs.uk
Collaborative commissioning priorities
To establish collaborative commissioning forums with CCGs in each hub, and delivery of the year one work plan
To design, develop and implement with key partners a collaborative commissioned Birmingham Oncology Prime provider model.
Through collaborative commissioning boards, scoping with CCGs joint ventures for improvement in access and pathway integration in CAMHS and Learning Disability services.
Implement locally the national TC programme to enable a strategic shift in provision, that meets the needs of services users in the community and reduces the number of service users in an In-Patient setting.
Through collaborative commissioning boards develop and implement a transition plan for the devolution of specialist weight management and surgery commissioning to CCGs in 16/17.
www.england.nhs.uk
Priority Area Project Outputs
CAMHS Tiers 2-4 • Needs assessment and service review
• Lead Provider/ service Integrator
procurement for Tiers 2-4
Learning Disability and
Autistic Spectrum
Disorder Services
• Development of local Strategy for LD
• Utilisation of information to inform provision
needs
Bariatric Surgery (but
including the pathway
from tiers 0-4)
• Transition plan for devolution in 16/17
(inc consideration of regional/UoP policies
and pathways)
Cancer (Birmingham
UoP)
• Lead Provider procurement for OP and
Chemotherapy.
Collaborative Commissioning Work Plan Priority Areas
www.england.nhs.uk
Priority Area Project Outputs
Neuro-rehabilitation • Needs assessment and service review
• Recommendation for pathway improvement
and new models of care
Paediatric ITU/HDU
(Inc Long Term
Ventilation
• Review of activity in each levels of care,
pathways, flow and blockages for pathway
redesign.
Neurosurgery and
Spinal Services
• Impact assessment of national pathfinder
• Recommendations for implementation
Renal Dialysis • Transition plan for future devolution (wont be
16/17) (inc consideration of regional/UoP
policies and pathways)
Collaborative Commissioning Work Plan Priority Areas
www.england.nhs.uk
Collaborative Commissioning Work Plan Priority Areas
Other areas frequently identified
Renal
Bariatric
Cancer
Vascular
Cardiac Devices
Neonatal
HIV
www.england.nhs.uk
Collaborative Commissioning Work Plan Priority Areas
An opportunity to build something lasting…
32
Mind the gap
© Amy Helene Johansson
©2015 MFMER | 3450630-36
…and a network to deliver
specialty expertise
David Hayes, M.D.Medical Director, Provider Relations
Mayo Clinic
A changing
health care landscape
©2015 MFMER | 3450630-37
After 150 years...
3 PRIMARY LOCATIONS
59,500 EMPLOYEES
1.3 million UNIQUE PATIENTS come for care each year
4,200 PHYSICIANS & SCIENTISTS
Mayo Clinic
Health System GA, IA, MN, WI
Mayo Clinic
Care Network 19 STATES, Puerto Rico & Mexico
©2015 MFMER | 3450630-38
Mayo Clinic
A Model of Care
A team of experts focusedon one patient at a time
Integrated clinical practice, education and research
Living values of collaboration, compassion, and innovation
Delivering patient care with respect, quality, and excellence
©2015 MFMER | 3450630-39
Our MissionTo inspire hope and contribute to health and well-beingby providing the best care to every patient through integrated clinical practice, education and research
Our VisionMayo Clinic will provide an unparalleled experienceas the most trusted partner for health care
Our Primary ValueThe needs of the patient come first
©2015 MFMER | 3450630-40
Mayo Clinic’s Vision
Provide an unparalleled patient experience
To all those who wish to have a relationshipwith Mayo Clinic
Regardless of geographic location
©2015 MFMER | 3450630-41
Mayo Clinic Strategic Plan
Transformthe Practice
Achieve OperationalExcellence
ExpandOur Reach
PE
OP
LE
PR
OC
ES
SE
SO
UT
CO
ME
S
GO
AL
S
Deliver Highest-Value Care toBe Most Trusted and Affordable
Achieve Mission-AdvancingFinancial Performance
Invest in Talent and Technology
©2015 MFMER | 3450630-42
Mayo Clinic reached
more than 69 million people in 2014
Goal: 200 million people by 2020
1.3M unique patients
from every state and144 countries
9M patients through
Mayo Clinic Care Network
4.1M unique diagnostic
tests from >130 countries
13M people through
Mayo’s social media channels
41.9M people through
products & services
©2015 MFMER | 3450630-43
U.S.demographics
Government& payer
initiatives
Rapidchanges in technology
Consumer factors
Health caremarket
forces & competition
Challenging Health Care Market
©2015 MFMER | 3450630-44
U.S. health care today
Fragmented and variable
High cost, low value
Unsustainable health care spending
Integration is recognized as key to addressingthe issue
Mayo Clinic has demonstrated that integratedcare promotes high value
Trend toward consolidation through mergersand acquisitions
©2015 MFMER | 3450630-45
Change
is rampant
©2015 MFMER | 3450630-46
Mayo Clinic Strategy
Preserve patient choice through strengthened relationships with patients and providers
Primary Tactics Payer strategies (contracting, alternative reimbursement models)
Government relationsMayo Clinic Care Network
Mayo Clinic Care Network Value PropositionSupport independent medical centers by extending knowledge and expertise to enhance patient care delivery
©2015 MFMER | 3450630-47
The Mayo Clinic Care Network:
A different kind of business model
Establish non-traditional relationships that increase accountability and risk-sharing to deliver quality care
Share knowledge and our integrated model of care (core business)
Drive clinically meaningful activity to improvepatient care at local sites and facilitate integrated carewith Mayo Clinic as appropriate for patients
©2015 MFMER | 3450630-48
“We are collaborating with likeminded health organizations ....Physicians have direct access
to Mayo specialists, services and toolsthat help them with their patients in the moment
and help them improve care.”
John Noseworthy, M.D.President and CEO, Mayo Clinic
— Meet the Press, January 2014
©2015 MFMER | 3450630-49
Locations
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Mayo’s Health Care
relationship continuum…
Good
friends
Mayo Clinic Care Network
Ownership
• eHealth Initiatives
• Knowledge Extension
• Health Care Consulting
Areas of Focus
©2015 MFMER | 3450630-52
Keeping Patients
Close to HomeeHealth
Services
Knowledge
Extension
Health Care
Consulting
Knowledge
Extension
AskMayoExpert (AME)
Grand Rounds
Patient Education
eHealth
Services
eConsults
eTumor Board
Health Care
Consulting
©2015 MFMER | 3450630-53
Mayo Clinic Care Network
Benefits to Members
Local providers have access to resources that mayobviate need for additional, independent input
Keep patients local that may not benefitfrom travelling to another medical center
Stem ‘out-migration’ for second opinion
Take advantage of Mayo Clinic processesand practices to avoid ‘recreating the wheel’
Secure information sharing is HIPPA compliant and uses Mayo Clinic’s login-authenticated, web-based portal
©2015 MFMER | 3450630-54
Mayo Clinic Care Network
Benefits to Patients
Avoid unnecessary travel
Additional input with no additional cost
Greater peace of mind
Facilitated referral, if appropriate
©2015 MFMER | 3450630-55
Mayo Clinic Care Network
What’s in it for Mayo?
Relevance
Power of a network in a rapidly changinghealth care landscape\
Developing new tools for internal use
©2015 MFMER | 3450630-56
Mayo Clinic Care Network
What it’s not:
Not meant to imply any local ‘need’
Not meant to upset current relationships
Not meant to force anything upon anyone
©2015 MFMER | 3450630-57
Mayo Clinic Care Network
Tools – Present & Future
Present
Asynchronous eConsults
AskMayoExpert
Health Care Consulting
eTumor Board Conferences
Archived Grand Rounds
In pilot or ‘soon’
Extension of Maintenance of Certification Part IV quality review boards
Population health management
©2015 MFMER | 3450630-58
eConsults
What are they?
Electronic method for specialists to respond to a physician’s focused questions about diagnosis, therapy or management through review of patient’s electronic medical record, imaging studies and laboratory tests.
Specialist to specialist/sub-specialist
In some instances, from primary care to specialist
Non face-to-face treatment recommendation
Asynchronous, fully documented interaction
Two business day turnaround from receipt of question and supporting materials
©2015 MFMER | 3450630-59
Example
Order Screen with Sub-specialty
©2015 MFMER | 3450630-60
eConsult
Current and Future Status
Most frequent requests are to oncology, hematologic malignancies, neurology, cardiovascular
eConsults can be obtained from any service line
As new Mayo Clinic services are added they are available to network members
Individualized Medicine Clinic
Regenerative Medicine Clinic
©2015 MFMER | 3450630-61
AskMayoExpert
Unique repository of clinical information developedby Mayo Clinic physicians, initially for Mayo use
Provides Mayo Clinic-vetted medical knowledge and expertise for use at the point of care
Essential answers to clinical questions, important factson clinical topics and expert contact information
©2015 MFMER | 3450630-62
AskMayoExpert
Captures, organizes, and delivers Mayo-vettedmedical knowledge at the point of care
Uses the concept of “gist” – concise and to the point but translated through experts
Target audience
Generalists
Specialists outside their specialty area
©2015 MFMER | 3450630-63
Content creation and update
AskMayoExpert uses Knowledge Content Boards consisting of five to six physicians representingtheir department or division plus one generalist
Content is reviewed at least annually but updatedmore often if necessary
©2015 MFMER | 3450630-64
©2015 MFMER | 3450630-65
Care Process Models
The Mayo Clinic Approach
©2015 MFMER | 3450630-66
Health Care Consulting
What is it?
Access to Mayo Clinic knowledge and experience
Best described as a sharing of best practices
Tailored to unique member health care needs
Supports efforts in realizing desired levels of financial, operational and patient care excellence
Tailored to unique requests
Specific consulting services and dedicatedMayo Clinic staff available
©2015 MFMER | 3450630-67
Health Care Consulting
Opportunities
Identified in various ways including:
During the membership due diligence process
Through member’s goal setting and gap analysis
By Mayo Clinic and MCCN member throughoutthe duration of the relationship
©2015 MFMER | 3450630-68
Health Care Consulting
Top of mind examples
Project charter template
Physician evaluation template
Medication and solution labeling policy
Medical staff appointment process
Mayo Clinic quality structure
Social Media policy and strategies
©2015 MFMER | 3450630-69
Health Care Consulting
Peer-to-Peer engagement examples
Service: patient engagement and experience
Quality, safety, accreditation
Nursing leadership, integration, competency, education
Physician engagement, leadership development
Simulation and innovation
Internal communications, employee engagement
Branding
©2015 MFMER | 3450630-70
Path to network membership
Four-stage internal approval process
Due diligence evaluation of candidate
Desk review
Site visit
Final internal recommendations include strengthsand challenges
“Challenges” often can be addressed throughhealthcare consulting
©2015 MFMER | 3450630-71
Ongoing Evaluation
Annual assessment of specific metrics
Annual ‘anniversary’ analysis of relationship
Annual face-to-face gathering
Site leaders and leadership
For some organizations regularly scheduledconference calls
©2015 MFMER | 3450630-72
Relationship Building
(In addition to portfolio tools)
Provider App for tools, information on mobile devices
Yearly C-Suite symposium for members
Provide updates
Assess available tools
React to future tools
Initiate new collaborations
Ad-hoc symposia to assemble other key groups
Chief Nursing Officer Symposium
Clinical Leadership Symposium
©2015 MFMER | 3450630-73
Future plans
Staged network growth
Continued international expansion
Expanded resources/tools for researchand education
Population management/analytics
Assess ‘Care Process Modules’as performance metrics
©2015 MFMER | 3450630-74
©2015 MFMER | 3450630-75
Value Proposition: Collaborative
Health Care Innovation
Health Care’s
Biggest
ChallengesAcademicinstitutions
Technologyleaders
Life sciencescompanies
Commercialpayers/
Employers
Governmentresearchers
Health careproviders
Patient/Consumer
organizations
Tackle the biggest issues in patient care withthought leaders across the industry
Develop data-driven strategies with unique data sets
Leverage cutting-edge data science methods
Accelerate research outputs into clinical translation
Advance policy agenda
Participate in national, high-impact initiatives, called “constellations”
©2015 MFMER | 3450630-76
The health care big data opportunity and challenge
>33 million
20+ years
unlinkable
claims
1,500+ data fields:• Medical claims
• Pharmacy claims
• Lab claims and results
• Health risk assessments
• Standardized costs of care
• Race
• Income
• Education level
• Household
• Geography
• Mortality
Tests,
treatments
315 million U.S. population
>129 million
20+ years
linkable
claims
>31 million
3 to 7+ yrs.
clinical
Expanded insights with deeper clinical context
250+ additional data fields:• Encounters
• Vitals (BMI, BP, heart rate …)
• Labs
• Medication orders
• Procedures
• Admissions, discharges and transfers
• Patient-provided information
>37 million
consumer
behaviors
300+ additional data fields:• Consumer behavior: general trends
• Demographic view including income, assets, home value, education level, marital status, occupation, home ownership, household make-up (multi-generational, presence of: children, grandchildren, grandparents), ethnicity data
• Psychographic data including interest and participation in: travel, various leisure activities, charitable giving, advocacy, volunteering, community involvement
Payment
System
Accountability
14 July 2015
SHCA
GOV.UK/monitor
2012 Act splits the payment regulation role between
NHS England and Monitor
Monitor leads on:
How the care to be
delivered is priced
NHSE leads on:
Designing how care is
delivered
Close working
and agreement
It influences the decisions made by commissioners and
providers…
…and, in turn, can improve quality of outcomes for
patients
Our price setting
role has potential
to bring
significant
benefits to
patients
Prices for £72bn NHS care are regulated by the
National Tariff
83
… a national price
list and variations
about prices
£31bn of care … rules for
determining local
prices
£41bn of care
What are we trying to do through the payment
system?
84
Maintain and improve
the current system
• Greater transparency
and openness
• Better payment
models
• Greater understanding
for patients and
providers of how the
payment system
works
New system
• More focused on
value, not activity
• Enables/ supports
new models of care
via appropriate
payment methods
Develop payment
models
Support areas in
testing new payment
models
Allow flexibility and
pick up ideas being
tested locally
Better cost, quality
and activity data
Value =Health outcomes
Costs of delivering the
outcomes
Health Care Vision 2020
Competing to Deliver the Greatest Value to Patients
Value here is defined and measured from a patient’s perspective
across the complete care pathway
The central goal is value for patients
Meet clinical
team
Possible need
for intervention
Shared
decision-making
Pre-intervention
testing
Clinical
outcomes
Patient satisfaction
and reported
outcomes
Patient
problem
Assess
appropriateness
Assess risk Schedule
intervention
Intervention Recovery
Existing reimbursement approaches, however, are not
aligned with value creation and delivery
Main
payment
approaches
CapitationProviders paid for the full care
needs of a population
Pros:
• Encourages coordinated
preventative care
• Flexibility to innovate
• Helps with cost containment
Cons:
• Requires significant
capabilities to coordinate
between professions and
information systems
• Providers carry risk when
treating more complex
patients
• Incentive to target healthier
people
Block contractsProviders given a fixed amount to
provide a service (or set of services)
for a period of time
Pros
• Providers have incentives to
prevent demand for their services
and improve productivity
• Flexibility to innovate
• Provides financial certainty in a tight
budgetary environment
Cons
• Possible long waiting lists
• Possible risk of under-treatment or
delayed treatment
• Does not encourage transparency
over costs and activity
Activity based
paymentBased on the concept of
“money follows the patient”, a
provider is paid for each
episode of patient care
Pros
• Incentive to improve
access and care quality to
attract patients
Cons:
• Providers have incentives
to provide as much care as
possible
• Providers paid even when
performing unnecessary
tests and procedures
• Innovations in new services
may be discourages as
these are not reimbursed
Existing payment models
Outcome-Based Bundled Reimbursement
Fixed payment Activity Payment Performance Payment Total Payment
£
Standard Payment
Risk Adjustment
Fixed Payment
To cover infrastructure
and coordination costs of
providing care
Performance PaymentActivity Payment
Swedish Spine Bundle
Standard Payment
Risk Adjustment
Using a variety of payment approaches may lead to better
value for patients
Payment based on patient
volumes, risk adjusted for e.g.,
age, gender and comorbidities
Payment based on
outcomes, with risk
adjustment
Current work in increasing transparency in specialised
services for the payment system
Ensuring clinically relevant prices
Standardising services and prices
Testing new payment approaches for specialised services
Increasing the transparency of the national tariff payment system
88
The work will be guided by a sector advisory group on
payment of specialised and complex care
89
