gpcc workshop in e midlands 23 nov 2010 v2

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Page 1: GPCC Workshop in E Midlands 23 Nov 2010 v2

7/26/2019 GPCC Workshop in E Midlands 23 Nov 2010 v2

http://slidepdf.com/reader/full/gpcc-workshop-in-e-midlands-23-nov-2010-v2 1/14

WORKING DRAFT

Last Modified 23/11/2010 15:39:17 GMT Standard Time

Printed 23/11/2010 14:41:03 GMT Standard Time

Supporting GP onsortia

!"S #$ST M%&L$!&S

!o'em(er 2010

)or*s+op materia,s

-!.%&#!T%$L $!& P-P%#T$ $n use of t+is materia, it+out speifi permission of Minse ompan is strit, pro+i(ited

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Minse ompan

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odified23/11/201015:39:17

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2

Four key issues to solve to get GP commissioning right

18ontro,:

-ners+ip o'er de,egated (udgets (ot+ forimpro'ed ser'ies and managingperformane

28Management ost:

a,ane need for ,oa, re,ations+ips and sa,e

38is*:Poo, and ap it+in !"S

48Performane:Manage t+e mone and outomes at pratieand ,uster ,e'e, from da one

.ous toda

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Contents

An aroach to management cost

 $n approa+ to finania, ris*

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GP consortia commissioning costs are ro!ecte" to #e a#out $%& er hea"

a'ter management cost re"uction

()*+)*(

;/17/1;

;/17/1;;/17/1; ;/17/1; $,, spend1

()*+)*(

;/17/1;

!on6GP onsortiaommissioning osts2

< per +ead

1 $,, ommissioning spend= i8e8= e>,uding a,, pro'ision spend and a,, training spend2 ommissioning oard= Loa, $ut+orities!ote: %f GP management osts a,,oane is a,u,ated using management osts definition= t+e fo,,oing ommissioning osts ou,d ount as ?non6

management@ and (e e>,uded: pa osts for non6managers and for managers paid (e,o t+e sa,ar t+res+o,d AB<30*CD non6pa osts of GPommissioning= in,uding re,e'ant proportion of s+ared ser'ies= ,inia, go'ernane

Management osts

!on6management osts

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Current N,- commissioning costs are alrea"y at the lo.er en" o'

international health systems

S-E#: .or non6E ountries: -#& 2010 "7 F e>penditure on +ea,t+ administration insuraneD %$ or,d fat(oo*Apopu,ationCD E data not in -#& ana,sis= so for urrent !"S= <;4 per apita mgt spend used: team ana,sis

Oerating costs as a / o' total health costs0 %112 3 managers er %41k atients that this 'un"s*

1 250* +osen as representati'e of sma,, PT8 a,u,ation assumes a'erage a,,6in pa osts of 75* / <50* for managers

;/17/1;

()*+)*(

;/17/1;

;/17/1;

;/17/1;

;/17/1;

;/17/1;

;/17/1;

;/17/1;

;/17/1;

;/17/1;

;/17/1;

;/17/1;

;/17/1;

;/17/1;

;/17/1;

;/17/1;

;/17/1;

;/17/1;

;/17/1;

;/17/1;

;/17/1;

;/17/1;

)- %! P-G#SS

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5arger consortia can invest more in commissioning sta'' an" resources

S-E#: Minse ana,sis

   6  a  n  a  g  e  m  e  n   t  a   l   l  o  .  a  n  c  e   7   $  m   8

!ote: assumes fi>ed oard osts of <1m= fi>ed ,inia, staff osts of <08;m= and a,,6in staff osts of <70* per person

Poulation

;/17/1;

;/17/1;

;/17/1;

;/17/1;

;/17/1;

;/17/1;

;/17/1;

;/17/1;

;/17/1;

;/17/1;

;/17/1;

;/17/1;

;/17/1;

;/17/1;

;/17/1;

 $ onsortiumo'ering 250=000,i'es ou,d fund up toB50 posts

 $ onsortiumo'ering 500=000

,i'es ou,d fund up toB120 posts

 $ onsortiumo'ering 50=000 ,i'esou,d strugg,e too'er its fi>ed osts

 $ minimum siHe is reIuiredfor a (udget t+at (rea*se'en on fi>ed ostsAappro>8 150=000 ,i'esC

Larger siHes t+en a,,o formore (udget t+at an (espent on managers and

ot+er resoures et8

"o man managers i,,ou needJ )+at ro,es i,,t+e p,aJ #8g8  $ounta(,e offier  .inane diretor 

Media, diretor  Strateg -perations AontratsC et8

<20 per +ead

<18;m fi>ed osts

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7

-uggeste" 9uestions to "iscuss

)+at are t+e tradeoffs of a mu,ti6tier arrangementJ %f ou+oose to pursue it= +at +appens at +i+ ,e'e,J

)+at information do ou need to ma*e deisions on tradeoffsJ

*

%

:

%s t+is suffiient, ,earJ

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K

Contents

 $n approa+ to management ost

An aroach to 'inancial risk

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9

There are 'our ma!or sources o' 'inancial risk;;;

S-E#: M Media, is* Group

-ource o' risk Imlications

onsortia an mitigate ( (eing,arger in siHe

Descrition

Managementris*

onsortia an diret, ontro,'ia ontinuous performanemanagement

ariation dri'en (differenes in media, prtie

Supp, ris* ariation dri'en (differenes in pro'iderstruture e8g8 "ospita,densit

&emand ris* ariation due to differenesin media, demand in t+eonsortium at+ment area

%ntrinsi ris* ariaiton not dri'en ( andistinguis+a(,e fator e8g8andom statistia, 'ariation

onsortia ma mitigate (

(eing ,arger= if t+e o'er areasit+ different demandD &" anredue 'ia a,,oation formu,a

onsortia ma mitigate ((eing ,arger in siHe= if t+eo'er areas it+ differentpro'ider struture

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<an" they .ill cause "e'icits in some consortia

;/17/1

;

;/17/1

;

;/17/1

;

;/17/1

;

;/1

7/

1020304050;0

S-E#: &" P too,*it 2010/11D &" #>position oo*s 2007/0K

Surp,us

&efiit

-urlus)"e'icit

Perent

GP ractices

Perent

6 6 6 6 6 6

Sum ofdefiits:<381(n

#stimated surp,us/defiit at GP Pratie,e'e, is (ased on fair s+areN of PT(udgets Aneeds eig+ted popu,ationC=and s+are of ommissioning spend

Praties are mu+ more susepti(,eto 'ariations in spend due to t+eirsma,, siHe= and so +a'e 'er iderange of performane Asurp,us/defiitsup to O/630 of (udgetC

Tota, defiits are <381(n

=stimate" surlus)"e'icit 'or in"ivi"ual GP

Practices A2007/0KC

=>amle? GP

Practice A

#>amp,e: GP Pratie $= it+ 10=000patients and 4 GPs= ou,d +a'e <2mdefiit: t+atNs <085m defiit/GP or<200 defiit/patient

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There are 'our levers that .ill #e use" to manage the risk

S-E#: M Media, is* Group

@se the right

allocation'ormula

Increase scale

aroriately

Reinsure

=nsure

oerational

e>cellence

What this means

Go'ernment must set a,,oation formu,a to mat+ under,ing needs of

popu,ation as ,ose, as possi(,e !e'er 100 mat+ed to under,ing needs= (ut an (e tea*ed Sets onte>t for GP operations

.inania, ris* fa,,s as onsortium siHe inreases "oe'er= it an (e toug+er to ensure strong mutua, aounta(i,it in

,arge organisations

onsortia ou,d poo, toget+er a ontingen in ase of pro(,ems

onsortia an ut osts= and t+us redue ris* of fai,ure= ( ensuringoperationa, e>e,,ene

T+is s+ou,d (e main da6to6da fous of ommissioners

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Financial risk 'alls as consortium sie increases

S-E#: Minse Media, is* Group= Monte6ar,o6Simu,ation (ased on atua, 200K data of German paor 

Pro(a(i,it of (eing in defiit( 1 of (udget or more

1M

-ie o' consortiumPopu,ation

;/17/1;;/17/1;;/17/1;

;/17/1;

;/17/1;

;/17/1;

=>amle? Consortium A

o' *10111 lives .oul"

have a "e'icit every * in :

years

=>amle? Consortium B

o' :110111 lives .oul"

have a "e'icit every * in%1 years

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-ie o' consortium!um(er of ,i'es o'ered

;/17/1;

;/17/1;;/17/1;;/17/1;

;/17/1;

;/17/1;

;/17/1;

Reinsurance coul" signi'icantly re"uce risk0 #ut at a material cost

=>amle? N,- reinsurance ool 'or high cost atients set at threshol" o' :1> average costs

S-E#: Minse Media, is* Group= Monte6ar,o6Simu,ation (ased on atua, 200K data of German paor 

onsortia it+ defiits Q 1 of inome

Perent

;/17/1;

;/17/1;

;/17/1;

;/17/1;

;/17/1;

;/17/1;

/ o' risk retaine" #y GPsremium as / o' income

#>amp,e: if onsortia o'ered 30=000 ,i'es= t+efration +o ou,d +a'e defiit Q1 ou,d (e:

35 if onsortia retained a,, t+e ris* 21 if onsortia retained K0 of ris*

7 if onsortia retained ;0 of ris* 284 if onsortia retained 40 of ris*

084 if onsortia retained 20 of ris* 0 if onsortia retained no ris*

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-uggeste" 9uestions to "iscuss

)+at ou,d (e t+e onseIuenes of a ris* oming to fruition=e8g8= a defiit ourringJ

an ou poo, toget+er to redue ris*J)+at ou,d t+at mean in pratieJ

*

%

:

%s t+is suffiient, ,earJ