Outcomes Based Commissioning in Oxfordshire Catherine Mountford, Associate Director of Strategy and Governance 19 th June 2013
Why outcomes based commissioning? Current commissioning converts money into activity, not outcomes Incentives are not aligned to maximise benefit Current approach is financially unsustainable Move to integration requires a different approach
What is outcomes based commissioning? Commissioning that rewards value for money and outcomes Each contract would cover care for a defined cohort Budget for all care for this cohort and to deliver outcomes Capitated Outcome Based Incentivised Contract one approach
OCCG priorities Three areas identified to have outcomes based contracts implemented from 2014/15 Maternity Mental health 2 groups o Anxiety and Depression o Psychosis Older People including dementia Ambitious as cover about one-third of our commissioning spend
What does it mean for providers? Completely different approach and behaviours required Contract form needs to be different Some options identified in our phase 1 work http://www.oxfordshireccg.nhs.uk/newsand-media/news-articles/outcomes-basedcommissioning/
5 Commercial Overview 5.7 OPTIONS FOR ROUTES TO CONTRACT State of Market (number of providers) Few many Complexity of service Degree of Integration required Commissioning structure options Commissioning route options Full competition Simple Limited Range of providers competitively procured ITT or Framework Full competition Complex Full Consortia competitively procured Competitive dialogue No competition Simple Limited / Full Development of the market Development of the market No competition Complex Limited Single provider Single action tender with strong partnering & incentivisation No competition Complex Full Lead provider with back to back subcontract arrangements Some competition in specific service areas but with one dominant (lead) provider Some competition in specific service areas with several dominant (key) providers Complex Full Lead provider with competition for subcontracts Specialist integrator with back to back arrangements to dominant provider and sub contract providers. Complex Full Lead provider with competition for subcontracts Specialist integrator with back to back arrangements to key providers and sub contract providers Single action tender with strong partnering & incentivisation Diligence on subcontractors Single action tender for lead with strong partnering & incentivisation Competitive Dialogue for subcontractors As above with Competitive Dialogue for integrator Competitive dialogue for lead provider role Single action tender for key providers with strong partnering & incentivisation Competitive Dialogue for subcontractors As above with Competitive Dialogue for integrator Oxfordshire CCG - Commissioning for Outcomes, July 10, 2013 6
5 Commercial Overview 5.8 GENERIC PROS AND CONS OF EACH CONTRACTING ROUTE There are pros and cons for each Commissioning structure and when assessing the optimal one these should be taken into account to understand which Pros and Cons have a material bearing on the situation and which Cons can be mitigated. The key Pros and Cons are set out below, but are assessed on a scheme level in each service section. Potential commissioning structure Range of providers competitively procured Pros Cons Other considerations Competition in the market can drive quality and VfM Risk of poor integration Integration risk held by the Commissioner Consortia competitively procured Competition in the market can drive quality and VfM Some risk of lack of integration requires strong governance Contract awarded to Single provider Enables development of partnering collaborative approach No contestability or pressure to drive quality Quality may be sub-optimal in non core areas Lead provider with back to back subcontracting arrangements Specific services are provided by speciality providers Integrator risk with provider Limited contestability or pressure to drive quality Risk of compounding of required profit Back to back arrangements with step in rights may be required Lead provider with competition for subcontracts Specific services are provided by speciality providers Limited contestability or pressure to drive quality for lead provider Some competition for specific services Integrator risk with provider Risk of compounding of required profit Specialist integrator with back to back arrangements to key and sub contract providers Potentially some element of competition Requires strong contractual arrangements whereby risk is transferred to the providers and the integrators can effect change Oxfordshire CCG - Commissioning for Outcomes, July 10, 2013 7