gpcc workshop in e midlands 23 nov 2010 v2
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WORKING DRAFT
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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
7/26/2019 GPCC Workshop in E Midlands 23 Nov 2010 v2
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Minse ompan
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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
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)- %! 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
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$ 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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-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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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
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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;
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=>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
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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;
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/ 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