Upload
others
View
2
Download
0
Embed Size (px)
Citation preview
Outcomes Framework
DOCUMENT 18
Dudley Multi-Specialty Community Provider Outcomes Framework
The entire body of the MCP Outcomes will be structured across 4 themes:
1. Population Health
2. Access, Continuity and Coordination
3. Empowering People and Communities
4. System and Staff
See figure 1 below for the four themes and high level outcome descriptors.
Principles
Figure 1: MCP Outcome Framework Themes and broad outcome descriptors
The graphic above shows the high level view of the MCP Outcomes Framework.
Each theme has a number of outcomes incorporated within, with each outcome
item containing the following details:
• Description of the Outcome
• Brief description of the Outcome Goal
• The data source
• Frequency of data submission required
• Current performance where known
• Target/Requirement for year one of the MCP Contract
• Indicative targets for years 2 to 5 of the contract.
1
Dudley Multi-Specialty Community Provider Outcomes Framework
The MCP Outcomes Framework will be housed within specific schedules within the new
national MCP Contract (currently in draft form).
The MCP Outcomes will therefore be situated within distinct parts of the Particulars
Schedule 5 within the MCP Contract;
The entire locally developed MCP Outcomes Framework is therefore contractually split into
2 sections: ‘Non-Incentivised’, feeding into Schedule 5 Part C and ‘Incentivised’ feeding
into Schedule 5 Part D
Please note that NHS England are currently developing an MCP Health and Care
Framework (HCF). Some of these measures will form part of the Improvement Payment
Scheme (IPS) and will be nationally mandated; the remainder of the IPS items will be the
incentivised Dudley MCP Outcomes Framework.
Schedule 5 Part C : Local Quality and Outcomes Requirements (Annex 1)
This schedule will contain the locally developed MCP Outcomes but there is no financial
incentive or penalty attached to any of the Outcomes contained therein.
Schedule 5 Part D – Improvement Payment Scheme (Annex 1)
This Schedule will contain both the nationally mandated and locally developed
requirements that will be incentivised through ‘top slicing’ a proportion of the total Contract
value. Please note that the nationally mandated items are currently in development and
therefore not yet available. The Contract value proportion that will be allocated to
nationally mandated items is yet to be confirmed but the working assumption is that it will
be 2.5% of the total Contract value. It is proposed that the Contract value proportion
allocated to the locally incentivised items will be 7.5% of the contract value. Therefore the
total IPS Scheme will be 10% of the proposed £270m total Contract value (£27m).
The Contractual Context of the MCP Outcomes Framework
2
Locally developed MCP Incentive
Outcomes
A: Operational Standards
B: National Quality Requirements
C: Local Quality and Outcomes Requirements
D: Improvement Payment Scheme (IPS)
Locally developed MCP Outcomes
(not incentivised)
MCP Contract Particulars: Schedule 5
3
Outcome Targets
Outcome targets for the locally developed MCP Outcomes Framework have been derived
from historical data where available and based on a statistically significant improvement
from the baseline. At this stage, the targets are therefore indicative as this process will
need to be refreshed in the light of more recent data being available prior to Contract
signature.
Certain targets within the first 2 years of the Contract are not based on numerical
attainment but aligned to systems set up and/or baseline establishment. This is an
important feature which gives the MCP Provider transitional headroom to establish new
methodologies and data flows alongside managing the cultural shift to a truly outcomes
based contract.
Dudley Multi-Specialty Community Provider Outcomes Framework
Dudley Multi-Specialty Community Provider Outcomes Framework
The incentivised items within the local Dudley MCP Outcomes Framework will feed into the
IPS (see diagram above) and will be allocated a top sliced 7.5% of the total MCP Contract
value.
Over recent years Dudley CCG has developed a local GP incentive Scheme as an
alternative to the National Primary Care Quality Outcomes Framework (QOF). This new
scheme is called the Dudley GP Outcomes Framework (GPOF). Although the GPOF has
been developed independently from the MCP Outcomes Framework there are clear
synergies between both frameworks’ underpinning ambition. Therefore the GPOF is
incorporated within the MCP Framework in its entirety. However it is important to note how
this will work in practice.
• The GPOF incorporates Directly Enhanced Service(DES), Local Incentive Scheme (LIS)
and QOF items along with many newly devised outcomes.
• Dudley CCG cannot double delegate DES and QOF in whole or part to the MCP
Provider.
• Therefore the GPOF will be funded directly to GPs through the current Primary Care
mechanism with the exception of LIS’s. The LIS amount (currently £1.3m) will be ring
fenced within the larger MCP IPS.
• The whole of the GPOF is incorporated within the MCP IPS and all GPOF items are
allocated an incentive within the MCP IPS to incentivise matrix working where possible.
However, only the £1.3m for LIS’s is ring fenced (see diagram below).
MCP Improvement Incentive Scheme
4
7.5% allocated to the Local Incentivised items
D: Improvement Payment Scheme (IPS)
2.5% allocated to Nationally Mandated items
Local Dudley MCP Incentivised items
Dudley MCP Outcomes Framework
Non-Incentivised items
D: Improvement Payment Scheme (IPS)
Direct Enhanced Services
QOF New items
Direct Enhanced Services
QOF New items
Dudley GP Outcomes Framework
Direct Enhanced Services
QOF New items
Dudley GP Outcomes Framework
Direct Enhanced Services
QOF New items
GP Local Incentive Scheme (ring fenced value within IPS)
GP Local Incentive Scheme (ring fenced value within IPS)
Dudley GP Outcomes Framework (GPOF)
Local Incentive Scheme Not incentivised through Primary Care route
Local Incentive Scheme Not incentivised through Primary Care route
Total IPS Value = £27m
Nationally mandated items = £6.7m
Local Items = £20.25 of which £1.3m ring fenced for LIS’s
Primary Care Funding Route
Primary Care Funding Route
MCP IPS Funding Route MCP IPS Funding Route
5
Phasing of the Incentive Scheme reward by Outcome Framework Domain shown as a percentage
The financial incentive allocated to each of the Outcomes within the IPS will be achieved
against one of the following three achievement structures:
1. Meeting or exceeding the target values. Using historical data the current performance
level Confidence Limits are assigned across the 90% to 100% achievement reward.
This essentially offers the Provider a 95% likelihood of achieving 90% or greater of the
assigned reward for the particular outcome in question and gives the maximum reward
to a statistically significant improvement. Using this methodology the whole of the
practical financial risk likelihood within the MCP IPS can be calibrated to match the
current practical financial risk likelihood associated with current incentive schemes.
This ameliorates the risk of significant loss of income. In other words, historically across
the system 85% of incentive schemes have been achieved (15% [£2.084m] practical
financial loss risk likelihood on incentive schemes). By finely calibrating the MCP stretch
targets using statistical process methodology and auto-regressive moving annual
forecasting, the same financial loss risk value (not percentage) can be matched.
2. Achieving targets for metrics without underpinning historical data. Some
Outcomes (for example some of the new GP Outcomes Framework metrics) do not have
historical performance data to draw upon. In these circumstances targets have been
scaled based on the formerly agreed parameters (agreed during the GPOF
development).
The IPS incentive allocation will have distinct phases throughout the life of the 15 year
MCP Contract. The allocation to the Population Health Domain will more than double
during the entire span of the Contract (see chart below).
Dudley Multi-Specialty Community Provider Outcomes Framework
Where monies are retained for non achievement against the IPS, this money will be held by
the Commissioner. The Provider will be entitled to bid for this retained sum through a
business case mechanism but will need to demonstrate a cogent plan for rectifying any
performance shortfalls and accomplish all relevant milestones in order that the specific
retained monies can be released back to the MCP Provider.
A resetting of the targets associated with any of the outcomes may be required on an
annual basis due to new performance data being available. Any changes required for this
purpose can be enacted through the Variations clause of the MCP Contract.
However, it is not intended that the Outcomes will be reviewed for inclusion or exclusion on
an annual basis. It is proposed that these more fundamental reviews should be undertaken
on a 3 year cycle.
Once set, the reward proportions associated with the Outcomes are not intended to
change.
Exceptional circumstances may require consideration regarding any of the above and this
can be enacted through the Variation clause of the MCP Contract at any point.
An outline of the proposed process for monies withheld be the Commissioner
for IPS underperformance is described in Annex 3.
3. Transition and development targets. In the first 2 years of the MCP Contract some
of the Outcomes will require data capture systems and processes to be developed
and thereafter a baseline to be established. Therefore the achievement against these
type of Outcomes will be evidenced by Provider assurance reports.
For the IPS financial reward and predictive achievement For a worked example of how
the above methods would work in practice, see Annex 5
In addition to the above, the Incentive Scheme proportions allocated to each theme of
the Outcomes Framework within the Incentive Scheme will vary over the lifetime of the
Contract..
Business Rules for Changes to the MCP Outcomes Framework
6
MCP Outcomes by Service Group
All the Outcomes within the MCP Outcomes Framework have been mapped to the MCP
Service Groups within the Service Scope.
This matrix is presented in Annex 1.
Dudley Multi-Specialty Community Provider Outcomes Framework