Comment / Unlocking the mystery

A clinician taking part in a new value initiative – aimed at promoting collaborative working between clinical and finance teams – recently described costing and numbers as a ‘grey mystical world’. This was ‘something that other people did’,’ they suggested.

How many organisations would recognise this view in their clinical teams? It is a situation that has to change, especially if the NHS is to make the most of the increasingly rich flow of patient-level costing data that is being produced across the service. All acute providers are now making annual cost returns at the patient level and there are plans for mental health, community and ambulance service providers to follow suit in the coming years.

Clinicians that have pioneered the use of patient-level cost (PLICS) data – and you can find some of them in the list of winners of HFMA Clinician of the Year: Working with Finance Award over the last few years – suggest use of the data provides insights into how to improve services and outcomes for patients. And yet currently, awareness of the data outside of costing teams is not widespread.

The new Engagement Value Outcome (EVO) framework – developed by the HFMA’s Healthcare Costing for Value Institute in partnership with Future-Focused Finance – specifically targets this issue. As part of the programme, trained facilitators work with a core group of individuals at specialty level in a trust. Interacting over a few months, the goal is to improve their understanding of PLICS data and start using it to support improvements in efficiency and effectiveness.

EVO requires staff from different disciplines – clinicians, operational managers, finance and informatics – to work together for three two-hour sessions.

Four trusts – two acute, one mental health and one community – have recently piloted the framework. One of the acutes is University Hospitals Birmingham NHS Foundation Trust. Within the last two years it has massively increased in size following the merger with Heart of England NHS Foundation Trust, which created a real opportunity for newly formed teams to review and compare specialty data.  And EVO helped the teams to identify commonalities and agree priorities.

The feedback was that EVO strengthened working relationships between clinical services, informatics and finance at all sites. One participant described the EVO framework as a ‘launch pad  for trusts struggling with clinical and financial engagement.’

For many clinicians – doctors, nurses, allied health professionals – this was the first time they had seen PLICS data for their own patients. Perhaps more surprising was that it was also the first time for some finance business partners.

Experience at another acute pilot – Great Western Hospitals NHS Foundation Trust – demonstrates how the approach can lead to important action. A multi-disciplinary review of gynaecology patient-level data highlighted that the trust needed to improve the clinical coding of procedures as an initial step.  Wrongly coded procedures were not only having an impact on finance data, but also undermining the ability to benchmark clinical practice.

Away from acute services, Gloucestershire Health and Care NHS Foundation Trust, also managed to make valuable progress. A deep dive into PLICS community data identified that patients with diabetes who had attended a diabetes education programme consumed significantly less NHS resource than those patients who had not attended. The specialist diabetes nursing team had felt intuitively that the programme worked. But they had no hard evidence to prove it. And that was exactly what the previously unseen PLICS data provided. Armed with data to demonstrate the value of prevention, the trust is now creating a business case to expand the programme.

You can read more about the trust’s experiences in a new briefing published by the institute and FFF.

In a further example, a deep dive for community mental health teams at North Staffordshire Combined Healthcare NHS Trust revealed the significant opportunity cost of patients not attending their appointments. Clinical staff worked with the costing team to put together an improvement plan. Not only has this improved productivity, but an uptake in patient attendance may reduce the risks of patients having a mental health crisis.

What EVO has shown is that it provides a bridge between clinicians and finance/informatics professionals – giving clinicians a greater sense of ownership of service data and helping to unlock that grey mystery.

It is also bridging the gap between a theoretical model of value-based healthcare and one that is embedded in the day-to-day delivery of better care for patients. As one participant said: ‘If you do the right thing for the patient, your money will come right and EVO has evidenced this beautifully.’

To receive information on the upcoming beta version of EVO, please email [email protected]