Alumni story / Achieving value for patients

‘Value’ (defined as outcomes per pound spent) in healthcare is increasingly viewed as a mechanism for moving away from transactional reliance on metrics and activity to focus on outcomes achieved through the delivery of effective and efficient services as a means to achieve financial sustainability.

Work on defining value has focussed predominantly on clinical conditions and the acute end of the pathways. However, this doesn’t take into account the fundamental essence of value, which is achieved by encompassing a whole pathway of care. For those with more complex needs this often requires contributions from a range of providers beyond traditional clinical care.

Even achieving value across a single pathway of care for the generally healthy population is seldom achieved within a single organisation but requires a systems approach. A systems approach needs to be data-driven and requires more sophisticated understanding of the needs of the population and an acknowledgement that the existing payment and regulatory system is not currently aligned.

In Camden CCG, we used the stories of patients with complex inter-generational health and social care problems to understand three key insights.

• Care needs to be organised around achieving value for patients – and we have to approach it in more thoughtful and strategic ways.
• We need to plan and deliver on the wider system than traditional clinical care.
• Breaking the pattern requires long-term investment in prevention and early intervention.

We have developed a Population Health Management Tool that segments our population data using health care usage as a proxy for health need. We can then plan and deliver services tailored to meet those needs and to measure the value achieved.

Patients with complex needs (mainly elderly) defined ‘time spent at home’ as the most important outcome to them. Services were co-designed and co-produced across providers of health and social care to manage patients through a multi-disciplinary care-planning approach. As a result of this admissions and bed days have been reduced for this group of patients with a high level of need.

Linking deprivation data to our tool demonstrated the stark impact deprivation has on health care usage amongst children in Camden. Camden CCG and Camden Council invested in a programme (Altogether Better) that has implemented services across health, social care and education. A broader range of outcomes including for example, school achievement, children with additional needs reaching their full potential, children protected from violence, are all measured. These outcomes can only be achieved by many organisations working together and are intended to be a long-term investment into improved value.

For a range of long-term conditions we have established ‘value-based’ contracts. The Diabetes Integrated Practice Unit is delivered by a range of partners across health, social care and the voluntary sector and has improved outcomes and reduced costs (through reduced hospital use).

Overall the approach across commissioned services has enabled the CCG to become one of the top performing CCGs nationally, with reductions in elective and non-elective admissions and improved patient satisfaction with services.

‘Value’ has been achieved through working across the system, adopting a more integrated approach beyond individual organisations or parts of pathways. Local partnerships, clinical championship and a focus on quality improvement are vital. However to embed this approach requires re-thinking at a central level on the way data is used and the regulatory, assurance and financial incentives must be arranged to support it.