Nic AdamsonDAAT Partnership
Manager
Payment By Results –A partnership perspective
Introduction
This outlines Worcestershire’s approach to procuring an outcome focused treatment system.
It incorporates payment by results. The process was supported by RichardTamlyn from the Centre for Public Innovation.
Context
The service had never been subject to procurement
The system had several components, none of which worked effectively together
The system was very blocked, the Willy Wonka factory of treatment.
Planned discharges are low Lack of emphasis upon PSI System not resilient to change
The vision
An integrated drug and alcohol service Recovery orientated model For adults and young people Outcome focused delivery Focused on positive and sustainable
behavioural change Main outcome, sustained recovery Including payment by results
Procurement exercise
Describe the key outcomes your service will achieve
Outline the key performance targets you will use to achieve these outcomes
Tell us how many people will engage with your service each year, and of these, how many will achieve proposed performance targets
Year oneAllocating the costs
Total budget = 4million For year one 25% by results For year two 30% by results For year three 40% by results Calculations made to divide the outcomes
across domains, looking at activity and intensity.
Critical to get it right!
MILESTONE MANAGEMENT
What are milestones and how do they help?
Interim actions or accomplishments
User rather than service focused
A logical sequence
of ‘If… then…’
MILESTONES
1. Enrol in project 100
2. Attend 1st session 50
3. Drug free (1 month) 40
4. Demonstrate new skill 30
5. Complete as planned 25
PERFORMANCE TARGET
Drug free and using skills 10
at 3 months
OUTCOMES
Drug and crime free
Tier 3, Adult Drugs Funnel
Performance Target: 265 people will achieve 4 weeks drug free and be planned discharged
Milestone 1
Milestone 2
Milestone 3
Milestone 4
Milestone 5
Recovery plan agreed & identified
Demonstrate improvement against TOPs, (reduction in days of use, criminal activity and improvement in life quality
Achieve identified goals
Achieve drug free/occasional use
Sustain substance free for 4 weeks & planned discharge
1819
1364
1023
329
265
Payment point:
£1236.50 per outcome, up to a maximum payment of
£327,672.50
Evidence:
Halo, Case file Audit, TOP's data, skills consortium requirements
Domains of outcomes
Young people – tier 2 and 3 funnels Adult drugs – tier 2 funnel, tier 3 PSI and
a prescribing funnel and needle exchange funnel
Adult alcohol – tier 2 and tier 3 funnels Family services funnel
How will payment be managed?
Customer Milestones
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Full Proje
ct
Recovery plan
agreed and identified
Predicted
1819 Actual
Demonstrate
improvement against
TOP's
Predicted
1364 Actual
Achieve identified
goals
Predicted
1023 Actual
Achieve drug
free/occasional use
Predicted
329 Actual
Sustain substance free for 4
weeks and planned
discharge
Predicted
265 Actual
PERFORMANCE TARGET:
Of the 1819 with agreed recovery plans, 265 will sustain four weeks substance free and be planned discharged.
What were the key considerations?
Payment by results – year one is a test year, clear that future years will vary
Lot of work to spread the risk across domains Ensure that outcomes are not process driven Ensuring outcomes are internally driven, rather than
affected by extraneous factors such as housing availability
Ensuring accuracy of base line data and achievability of outcomes
Ensuring all parties are clear on what is required Involving all staff
What do we hope to acheive?
Focused service delivery Shift to outcome focused commissioning Shift to partnership commissioning Value for money A focus on behavioural change rather than treatment processes Service issues highlighted early Positive outcomes for service users Transparency between provider and commissioner, supporting
audit process A service based on hope and strengths rather than problems
and weaknesses
Lessons learned?
Still learning Shared risk Wait till year two to introduce fully Allow for transformational change Make sure outcomes are fair
Top Related