Cost Cube

Gerry Marr

Chief Operating Officer, NHS Tayside

NHS Tayside Cost Profile 2006/07

Total Cost Cube

Cost Cube Share of

Total£000 £000 %

Hospital & Community Costs 469,308 267,503 57.0%

Prescribing 76,205 76,055 99.8%

GMS 43,726 43,633 99.8%

Other FHS 31,116 - 0%

Administration Costs 4,932 - 0%

Other Non Clinical Services 9,916 - 0%

Total 635,203 387,191 61.0%

Hospital & Community£469.31m (73.9%)

Prescribing£76.21m (12.0%)

Other Family Health

£31.12m (4.9%)

Other Non-Clinical£9.92m (1.6%)

General Medical Services£43.73m (6.9%)

Administration£4.93m (0.8%)

Inpats & Day Cases£191,713 (30.2%)

A&E£5,595 (0.9%)

Prescribing£76,055 (12.0%)

Psychiatric£27,293 (4.3%)

Outpatients£35,175 (5.5%)

Labs£4,263 (0.7%)Radiology

£3,464 (0.5%)

Unassigned£248,012 (39.0%)

General Medical Services

£43,633 (6.9%)

Elective Inpatients£93,04424.0%

A&E£5,5951.4%

Prescribing£76,05519.6%

Psychiatric£27,293

7.0%

Outpatients (New)£35,175

9.1%

Labs£4,2631.1%

Radiology£3,4640.9%

Day Cases£17,099

4.4%

Non-Elective Inpatients£81,57021.1%

General Medical Services£43,63311.3%

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GP Practices

Cost per Head by GP Practice 2006/07 (incl. GMS)

Cost per Head by CHP (incl. GMS)

£924.94 £942.10£1,033.32

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Range of Variation from mean Cost per Head between GP Practices

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Psychiatry SMR04

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Radiology A&E

Elective Inpatients

Outpatients (New)

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Range of Variation from mean Cost per Head between GP Practices

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Psychiatry SMR04

A&ELaboratories

Radiology

GMS

GMS vs non-GMS Expenditure by Practice Population

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Non-GMS Spend per Head

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Costs vs Expected at Tayside Average (incl GMS)

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Cost vs Expected - Non Elective Inpatients (Anonymised)

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Cost vs Expected - Prescribing (Anonymised)

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The ‘Triple Aim’

Gerry Marr

Chief Operating Officer

NHS Tayside

The “Triple Aim”

Health of the Population

Experienceof Care

Per CapitaCost

15

Macro-Integrator

• It is not a new structure or organization

• It pulls together the resources to support a defined population

• It optimizes the Triple Aim for the sake of a defined population

• It works with and helps to improve micro-systems to support individuals

Some System Components to Accomplish the Triple Aim

• Individuals and families

• Redesign of “primary care” services and structures

• Population health management

• Cost control platform

• System integration

1. Individuals and Families

• Partnership between families and caregivers for learning and enabling.

• Memory of individuals anywhere they go

• Joint planning and customizing care on best feasible outcomes

• Patient-controlled personalized health record

2. Redesign of “primary care” services and structures

• Team definition

• Modes of access to services

• Medication management

• Cooperation and coordination with other specialties and hospitals

3. Population health management

• Useful segmentation of the population, for example by level of family support or by type of disease

• Use of predictive models to deploy resources to high risk individuals

• Services customized by segment• Convenient access to information about

health• Public health interventions

4. Cost control platform

• Defining and measuring per capita cost

• Target for inflation

• Break incentives for supply driven care

• New technology introduction

• Focus on the individual as a cost reduction strategy

• Yearly initiatives to reduce waste and the associated cost with all providers involved