Population Level Commissioning for the Future Wednesday 3 December 2014, 1pm – 1.45pm Dr Abraham George Assistant Director/Consultant in Public Health Kent County Council & Beverley Matthews LTC Programme Lead, NHS Improving Quality

1. WELCOME
Today’s Webinar
Population Level Commissioning for
the Future

2. Population Level Commissioning for the Future
Wednesday 3 December 2014
1pm – 1.45pm
Dr Abraham George
Assistant Director/Consultant in Public Health
Kent County Council
&
Beverley Matthews
LTC Programme Lead, NHS Improving Quality

3. Meet the Speakers
Bev Matthews
A nurse by background, Beverley has worked extensively throughout the NHS in a variety of
clinical, managerial and strategic roles. Beverley’s current role as Programme Delivery Lead
for Long Term Conditions Improvement Programmes: LTC Year of Care Commissioning
Model and LTC Framework. Prior to joining NHS Improving Quality in April 2013, Beverley
was Director of NHS Kidney Care and NHS Liver Care.
Passionate about service transformation through developing networks and leading complex
programmes. Providing strategic leadership to partners within health communities,
managing stakeholders and working across agencies
Dr Abraham George
Working in Kent since 2010, undertaking a challenging portfolio focused around
commissioning support for urgent care (including a unique countywide hospital bed
utilization review), end of life care and older people’s health including multiple morbidities.
He is also the public health lead on Individual Funding Requests, Clinical Effectiveness and
Kent County lead on the JSNA and Public Health Intelligence.
Providing valuable strategic and tactical support to the Kent Integration Pioneer
programme. Currently the public health lead for the Kent LTC Year of Care Commissioning
Model and, alongside this, has been promoting the importance and use of person level
linked datasets, enabling whole population integrated intelligence to support integrated
commissioning.

4. Learning Outcomes
Population Level Commissioning for the Future
of Care foundation.
 Understanding the design and development of
whole population person level linked datasets
 Understanding their application towards
commissioning of integrated care
 What are the key challenges and inter-dependencies
• The potential impact towards whole system
transformation

5. Beverley Matthews
LTC Programme Lead
NHS Improving Quality
Beverley.matthews@nhsiq.nhs.uk

6. Bespoke Support

8. Tools and Resources

9. Links
Long Term Conditions Dashboard
http://ccgtools.england.nhs.uk/ltcdashboard/flash/atlas.html
Long Term Conditions House of Care Toolkit
www.nhsiq.nhs.uk/improvement-programmes/long-term-conditions-and-integrated-care/house-of-care.aspx
SIMUL8: Simulation Model
http://www.simul8.com/viewer/download.htm
#LTCyearofcare #LTCimprovement @NHSIQ

10. LTC Learning Forum
“Lunch & Learn” Webinar Series
&
Bite Size Master-classes

11. LTC Learning Forum
“Lunch & Learn”
• 45 minute “real time” Webinar
sessions
• Topics agreed and learning outcomes
identified
• Faculty of Speakers identified
Open invitation
Bite Size Learning Master-Classes
• Pre-recorded 20 minute Master-classes
• Master-class either as stand alone
sessions or pre-requisites for
Wednesday “Lunch & Learn”
Webinars
• Faculty of Speakers identified
Open invitation

12. LTC Lunch & Learn Series ….coming soon…
To register email LTC@nhsiq.nhs.uk
Date Webinar Hosted by Bev Matthews &
7 January 2015
1 – 2pm
Self Management Support
Return on Investment
Renata Drinkwater
Chief Executive & Trustee Self
Management UK
21 January 2015
1 – 2pm
Commissioning for Outcomes Bob Ricketts CBE
Director of Commissioning Support
Services & Market Development,
NHS England
4 February 2015
1 – 2pm
Accountable Care Organisations
in the USA & England testing,
evaluating and learning what
works
Dr Rachael Addicot
Senior Research Fellow, Kings Fund

13. POPULATION LEVEL COMMISSIONING
FOR THE FUTURE
Dr Abraham George
Consultant / Assistant Director in Public Health
Kent County Council

14. Context
• Huge NHS and public sector funding gap
• Public sector services expected to discharge
statutory functions with ever shrinking budgets
• Growing need for ‘whole system’ understanding
how money and resources are being utilised for
population health and wellbeing
• Greater insight required to develop higher value
models of care that can meet the funding crisis

15. Context (cont’d)
20%
75%
40%
15%
Multiple complex
conditions
Single LTC/ at risk
Healthy / minor
risk
Population segments Cost

16. Context (cont’d)
Acute Community Mental Health Social Care Voluntary/
All PbR
(except YoC or
package
currencies)
Independent
Primary care
Primary care
prescribing
NHS England
as commissioner
Non-PbR block
contract
• PbR excl drugs
• Crit. Care
Personal
healthcare
budget
Specialised MH
Services
Means-tested
services (incl.
residential)
Rehabilitation
palliative &
end of life
Maternity pathway
• Reablement
• Adult Services
PbR MH
clusters
Children’s
services
GP services
Residential
continuing
care
Age UK

17. The challenge
“Shifting the focus away from reactive episodic
care, towards a proactive person centred capitated
funding model, irrespective of organisational
boundaries and disease based pathways of care”

18. Local Profile
• >1.5 million population
• Governance of
commissioning at multiple
levels
• 1 County Council, 7
CCGs, 12 districts, 4
acute trusts, 1 community
health trust, mental health
trust, >200 practices
• Public Health
Observatory team
• Well networked with other
intelligence teams
– JSNA development
– Health & Social Care Maps
– Local needs assessments
– Other analyses
• Links with K&M Health
Informatics Service –
data warehouse

19. Progress till date
• Work started in 2012 – QIPP LTC programme
• Whole population profiling using risk stratification
– Burden of multiple morbidities
– Impact on service utilisation - ‘Crisis curve’
– Estimating possible financial benefits of integrated care could be
realised
http://www.kmpho.nhs.uk/EasySiteWeb/GatewayLink.aspx?alId=382582
• Delivery of national YOC programme in Kent - implementation at
sub Kent / CCG level
• Kent Integration Pioneer – Key milestone
• Submission of linked datasets to national team for analysis
• Contribution to national guidance eg. MONITOR report of
designing linked datasets
• Currently working health informatics service to develop
dashboard

20. Population Commissioning for the future
• Longitudinal analysis of service utilisation and
costs for a patient cohort based on multi-morbidity
/ risk stratification
• A brief look at some of the graphs and charts in
the report

24. Kent LTC YOC programme
• All providers and commissioners involved
• 2/7 CCGs are the sponsor orgns
• KCC Public Health manages programme on behalf of
whole county
• Implementation at sub Kent level
• East Kent group first to take part and now finalising shadow
testing arrangements
• All professionals are involved – commissioner, finance,
informatics, etc.
• Use of risk stratification dashboard to monitor activity and
costs, evaluate integrated care models
• Data linkage at person level still not yet finalised, so linkage
currently at GP practice level

25. Identifying patients suitable for YoC
• Risk stratification tool applied
• LTC codes applied (18 in total - QoF)
• List segmented by LTC currency (Bands B – E applied -
B=2,C=3-5,D=6-8,E=9),
• Risk Score over time mapped (looking for rise in risk
score in last 6 mths – 4 of 6 show an increase) or
• Rapid Riser in last 3 mths (monthly increase in risk
score over past 3 mths and overall increase of
>15pts).
• Kent – 80 GP practices, Band B = 2197, Band C=
3506, Band D =261, Band E= 5 Total 6369 of 729, 275
• Now driving increased engagement in risk stratification

26. The Year of Care dashboard has so far presented 4 months of activity
and costs worth £57 million from 7 different provider organisations. Of
this £4 million (7% of total spend) represents the proportionate costs
for the YOC cohort (0.3% of total population).

27. Issues highlighted
Gap Identified by Date identified Action
No standard definitions for
Integrated Care across
system
East Kent Project Group Jan 2014 Flag to West Kent
Project Group and link
to Integrated Care plan
work
No method to share care
plans once MDT completed.
(Not even seen by GPs)
EK Project Group Feb 2014 Flag to SRO
Not all practices submitting
data to HISBi
East Kent Project Group
West Kent Project Group
April 2014
May 2014
Flag to SRO
Ongoing
PLICS and RiO system in
Kent Medway P’ship Trust
not flowing data correctly
KMPT when requested to
submit first data
submission
June 2014 Resolved by KMPT
No standard definition for
integrated care within Kent
Community Health Trust
Impact identified by
Programme on YoC ability
to assess impact of LTC
services Vs WP
July 2014 KCHT to standardise
definition. Recording
process agreed Sept
2014
Variable in recording
practice of GP codes in Non
–NHS data
Programme when we
introduced “black box”
solution
Sept 2014 Highlighted to
organisations. With 3rd
sector provided list to
facilitate update.

29. Key Challenges
• Information Governance is a key challenge
– Current approach to data sharing has been difficult – different
expert opinions on how share / link data
– National policy on data sharing for ‘indirect care’ is evolving eg. role
of ‘DSCROs’, Department Health consultation on ‘Accredited Safe
Havens’
• Data quality and accessibility
– Good support from provider organisations
– Quality / completeness of data variable across different
organisations
• Commissioner buy-in
– Still some way off in application toward CCG plans
– Difficult to change mind-set of commissioning capacity towards
outcomes.
– Long term planning of Business Intelligence provision in Kent
uncertain

30. Key Messages
• Opportunity to capitalise ‘big data’ in public sector
• Importance of person level linked datasets using
NHS numbers
• Using technology to accelerate the linking of data
from disparate sources
• Understanding the role of intelligence to develop
higher value models of care to incentivise
prevention and improve population health and
wellbeing
• Opportunity for business intelligence teams to
work together develop whole system intelligence

31. Further contact details
abraham.george@kent.gov.uk
fionuala.bonnar@kent.gov.uk
Beverley.Matthews@NHSIQ.nhs.uk

32. “Year of Care is a vital component of
Kent’s Integration Pioneer Programme –
with findings being used to underpin Kent’s
Better Care Fund” Jo Frazer – Kent
Pioneer Programme Manager
- “If this works that’s my job done”
- -CCG Head of Finance
“Kent have been successful in linking their transformation of services
with commissioning through the LTC Year of Care programme which
will make that step towards individualised care for people with
complex needs.” Beverley Matthews, LTC Programme Lead,
NHSIQ
“The intelligence from YOC is both informing our thinking on a more
progressive contracting approach incentivising real service
integration”- Hazel Carpenter, Accountable Officer CCG
“This is the first group I have been part of that has moved so far so fast”-
AD Finance Provider
“The year of care programme has been a great enabler in helping us focus
upon and design a holistic ‘health and social care’ model around individual
clients rather than individual disease pathways in a value added, integrated
manner.”- Sanjay Singh Chief GP Commissioner West Kent CCG

34. LTC Lunch & Learn Series ….coming soon…
To register email LTC@nhsiq.nhs.uk
Date Webinar Hosted by Bev Matthews &
7 January 2015
1 – 2pm
Self Management Support
Return on Investment
Renata Drinkwater
Chief Executive & Trustee Self
Management UK
21 January 2015
1 – 2pm
Commissioning for Outcomes Bob Ricketts CBE
Director of Commissioning Support
Services & Market Development,
NHS England
4 February 2015
1 – 2pm
Accountable Care Organisations
in the USA & England testing,
evaluating and learning what
works
Dr Rachael Addicot
Senior Research Fellow, Kings Fund