Transcript Strategic Assessment: Drugs & Alcohol in Worcestershire

Payment By Results –
A partnership perspective
Nic Adamson
DAAT Partnership
Manager
Introduction
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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
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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
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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
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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 one
Allocating the costs
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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
2.
Attend 1st session
3.
Drug free (1 month)
4.
Demonstrate new skill
5.
Complete as planned
PERFORMANCE TARGET
Drug free and using skills
at 3 months
OUTCOMES
Drug and crime free
100
50
40
30
25
10
Tier 3, Adult Drugs Funnel
Evidence:
Halo, Case file Audit, TOP's data, skills
consortium requirements
Milestone 1
Milestone 2
Milestone 3
Milestone 4
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
1819
1364
1023
329
Payment point:
Milestone 5
Sustain substance free for 4 weeks
& planned discharge
265
£1236.50 per outcome, up
to a maximum payment of
£327,672.50
Performance Target: 265 people will achieve 4 weeks drug free
and be planned discharged
Domains of outcomes
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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
Recovery
plan
agreed and
identified
Predict
ed
Demonstra
te
improveme
nt against
TOP's
Predict
ed
Achieve
identified
goals
Ap
r
Ma
y
Ju
n
J
ul
Au
g
Se
p
Oc
t
No
v
De
c
Ja
n
Fe
b
M
ar
Full
Proje
ct
1819
Actual
1364
Actual
Predict
ed
1023
Actual
Achieve
drug
free/occasi
onal use
Predict
ed
Sustain
substance
free for 4
weeks and
planned
discharge
Predict
ed
329
Actual
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?
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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?
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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?
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Still learning
Shared risk
Wait till year two to introduce fully
Allow for transformational change
Make sure outcomes are fair