Nic AdamsonDAAT Partnership

Manager

Payment By Results –A partnership perspective

Introduction

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

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

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

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 oneAllocating the costs

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 100

2. Attend 1st session 50

3. Drug free (1 month) 40

4. Demonstrate new skill 30

5. Complete as planned 25

PERFORMANCE TARGET

Drug free and using skills 10

at 3 months

OUTCOMES

Drug and crime free

Tier 3, Adult Drugs Funnel

Performance Target: 265 people will achieve 4 weeks drug free and be planned discharged

Milestone 1

Milestone 2

Milestone 3

Milestone 4

Milestone 5

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

Sustain substance free for 4 weeks & planned discharge

1819

1364

1023

329

265

Payment point:

£1236.50 per outcome, up to a maximum payment of

£327,672.50

Evidence:

Halo, Case file Audit, TOP's data, skills consortium requirements

Domains of outcomes

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

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Full Proje

ct

Recovery plan

agreed and identified

Predicted

1819 Actual

Demonstrate

improvement against

TOP's

Predicted

1364 Actual

Achieve identified

goals

Predicted

1023 Actual

Achieve drug

free/occasional use

Predicted

329 Actual

Sustain substance free for 4

weeks and planned

discharge

Predicted

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?

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?

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?

Still learning Shared risk Wait till year two to introduce fully Allow for transformational change Make sure outcomes are fair