norfolk pct wcc health market analysis workshop 1
TRANSCRIPT
Norfolk PCT WCC Health Market Analysis Workshop 1
19th December 2008Strictly Private & Confidential
NHS East of EnglandHealth Market Analysis
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Welcome and Introductions
Section 1
Welcome and Introductions
PwC Core Team
Ian Baxter
Ian Brooks
Rachel Abbott
Peadar O’Mordha
Cara Lewis
PwC Team
Healthcare Transactions Contracting &
Procurement
Clinical
Health Policy Market Analysis
Commissioning
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Agenda
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Timing Agenda item Key points and description for 19/12/20081 10.30-10.45 Welcome and Introductions • An introduction from John Harris
• What to expect from the workshop• Your team from PwC
2 10.45-11.00 The Case for Change • Key drivers for the current market analysis task• What are Norfolk’s key objectives for this exercise?
3 11.00-11.30 Walk Through of the Health Market Analysis • An outline of PwC’s “Seven Steps Methodology” of market analysis• A showcase of key deliverables• Discussion of how Norfolk can sustain market analysis
4 11.30-11.45 Key Findings for Norfolk PCT • Presentation of Norfolk’s balanced scorecard of outputs: five top stories analysed
5 11.45-12.30 Check and Challenge Discussions and Conclusions
• Group discussion of Norfolk’s top five stories• Identification of specific areas for market development actions
6 12.30-13.15 Introducing a methodology for market development action planning
• Definition of a health market• Outline of our three step methodology for market development action
planning
7 13.15-13.30 What to Expect from Workshop Two • Outline of workshop two’s action planning agenda
Our session this afternoon
Welcome and Introductions
•A live working session, co-designed with you
•An opportunity to review the Health Market Analysis and:
- identify demand and supply side characteristics- build up a case for change- identify your top stories- develop market analysis skills for Norfolk PCT- build a consensus on your priority issue to take forward to workshop two
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Welcome and introductions
?What are your expectations for today’s session?
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Evidencing the Case for Change
Section 2
Evidencing the Case for Change: What are the Objectives of Health Market Analysis?
•System reforms in place to create a managed market-Choice, PbR, WCC-Contestability & Plurality
•Markets, appropriately levered, can drive improvements in health outcomes for patients and value for money for PCTs and tax payers
•Health Market Analysis is a critical first step
•The underlying principal objectives of HMA are to
- present a structured approach to market analysis and stimulation
- support Norfolk PCT in building a case for change
- develop your own market analysis skills and understanding
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Evidencing the Case for Change: What are the Key Drivers for Health Market Analysis?
•Health Market Analysis is a key enabler to a larger system management picture
ASSURANCE
FRAMEWORK
C O N S T I TUT ION
Principles and Rules
Co-operation andCompetition Panel
Standard Contract
Promotion Code
Transactions Manual
Procurement Guide/Portal
Health Market Analysis
CHOICEPOLICY
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?Evidencing the Case for Change: Norfolk’s own ‘burning platforms’
•What is your local burning platform for analysing the market?
•How can market analysis support delivery of your WCC Commissioning Strategy Plan?
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Any changes must be based on evidence of a need for change
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Walk Through of the Health Market Analysis
Section 3
Attributes Needed to Sustain Health Market Analysis in Norfolk
Market analysis is not a “one off” project, constant analysis and evaluation is crucial for long term success
?What skills, capabilities and enablers are needed to take health market analysis and
market development forward?
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Taxonomy1
Demand forecasts2
Service analysis3
Economic attributes4
Priorities5
Options6
Road map7
PB Code PB Categories PB Sub Code
PB Sub-Category PRESS BUTTON FOR ADDITIONAL PROVIDER ROW
Provider Number of providers
PRESS BUTTON FOR ADDITIONAL PROVIDER ROW
Please add name of provider. For general practices, please amalgamate as one provider and indicate the number of providers in the next column (H)
1 Infectious diseases Not required Provider name £2 Cancers and tumours Not required Provider name £3 Disorders of blood N/A Provider name £4 Endocrine, nutritional and
metabolic problemsNot required Provider name £
5 Mental health disorders A Substance misuse Provider name £B Organic mental
disordersProvider name £
C Psychotic disorders Provider name £
PCTs are asked to provide data for every provider from whom they commission services, for each programme budget (or sub-category) listed. This could mean that data for some providers will appear in a number of programme budget categories, but the data entered in each row should relate to services commissioned from that provider for the relevant programme budget category
Corresponds to 2006/7 DH programme budget return
Approach to data collection1
Prevalence modelling
0%
5%
10%
15%
20%
25%
Under 5 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
Age Group
Current CHD prevalence - Male
Current CHD prevalence - Female
Projected CHD prevalence - Male
Projected CHD prevalence - Female
Prevalence modelling
0%
5%
10%
15%
20%
25%
Under 5 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
Age Group
Current CHD prevalence - Male
Current CHD prevalence - Female
Projected CHD prevalence - Male
Projected CHD prevalence - Female
Demand models2
Supply analysis3
Market analysis4
Balanced score card5 Market development options6
Road maps7
Health Market Analysis
The Case for Change: Approach to Market Analysis
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Taxonomy / Market Segmentation
1 Taxonomy
4 Economic attributes
2 Demand forecasts
3 Service analysis
5 Priorities
6 Options
7 Road map
The data collected was based on Programme Budget Categories and allowed further disaggregation
This approach underpins the new DH tool for PCTs
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Taxonomy / Market Segmentation
1 Taxonomy
4 Economic attributes
2 Demand forecasts
3 Service analysis
5 Priorities
6 Options
7 Road map
The data collected can be further disaggregated into market segments and re-aggregated into contracting units
Care pathwaysD
ise
ase
gro
up
s
X
X = market segment
= contracting unit
This approach underpins the new DH tool for PCTs
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1 Taxonomy
4 Economic attributes
2 Demand forecasts
3 Service analysis
5 Priorities
6 Options
7 Road map
Demand Forecasts
Understanding current and future market developments is essential to strategic commissioning
Demand forecasting identifies the underlying drivers of commissioning
Our approach to demand analysis and forecasting considered
• Population size;• Population age and ethnic structures;• Disease Prevalence;• Population lifestyle factors;• Patient service consumption behaviours.
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1 Taxonomy
4 Economic attributes
2 Demand forecasts
3 Service analysis
5 Priorities
6 Options
7 Road map
Demand Forecasts
Sample Output Demand Forecast Tool
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1 Taxonomy
4 Economic attributes
2 Demand forecasts
3 Service analysis
5 Priorities
6 Options
7 Road map
Demand Forecasts
The key output of the Demand Forecast Toolkit was the “Utilisation Risk Index”. This index quantifies the risk of an increase in service utilisation for a given Programme Budgeting (PB) Disease Category, allowing for:
- Changes in the size of the population- Changes in the age structure of the population - Changes in the ethnic structure of the population - Service consumption behaviours, once a patient has a complaint
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The analysis looks at the quality of health services along 5 metrics:
•Acceptability / Patient-centred
•Access / Timeliness
•Effectiveness/Safety
•Efficiency
•Equity
The selected metrics are specific to a PB Category, for example:
•Programme Budgeting Category: problems of circulation
•Quality criteria: access
•Metric: Number of patients waiting more than 9 weeks for elective
- admission for a vascular procedure
Service Analysis1 Taxonomy
4 Economic attributes
2 Demand forecasts
3 Service analysis
5 Priorities
6 Options
7 Road map
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1 Taxonomy
4 Economic attributes
2 Demand forecasts
3 Service analysis
5 Priorities
6 Options
7 Road map
Service Analysis
PCT dashboard of service quality – new metrics can be added to the model
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Economic Analysis1 Taxonomy
4 Economic attributes
2 Demand forecasts
3 Service analysis
5 Priorities
6 Options
7 Road map
Headline statistics
Market description
Expenditure
Providers
Contracting
Cross-PCT summary statistics
Summary expenditure
Summary providers
Summary contracting
EoE service patterns
Supply-side patterns
Demand-side
patterns
What do existing markets look like vs. the EoE average?
How do markets compare to those in
other PCTs?
What does East of England-level data tell
us about service attributes?
Key components of economic analysis
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Economic Analysis1 Taxonomy
4 Economic attributes
2 Demand forecasts
3 Service analysis
5 Priorities
6 Options
7 Road map
A skeletal model of economic analysis can be updated based on the initial data collection template
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Priorities1 Taxonomy
4 Economic attributes
2 Demand forecasts
3 Service analysis
5 Priorities
7 Road map
Service quality analysis
Prevalence modelling
0%
5%
10%
15%
20%
25%
Under 5 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
Age Group
Current CHD prevalence - Male
Current CHD prevalence - Female
Projected CHD prevalence - Male
Projected CHD prevalence - Female
Prevalence modelling
0%
5%
10%
15%
20%
25%
Under 5 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
Age Group
Current CHD prevalence - Male
Current CHD prevalence - Female
Projected CHD prevalence - Male
Projected CHD prevalence - Female
Example PCT dashboard
DiabetesMental healthStroke
Efficiency
Acceptability
Equity
Effectiveness
AccessQuality of supply
Appropriate workforce capacity
Appropriate volumeQuantity of supply
DiabetesMental healthStroke
Efficiency
Acceptability
Equity
Effectiveness
AccessQuality of supply
Appropriate workforce capacity
Appropriate volumeQuantity of supply
Strategic alignmentDemand analysis ExpenditurePCT Code
% PCT expenditure I II III IV V VI VII VIII IX X XI XII XIII XIV1 1% 1% 1% 1% 1% 2% 1% 2% 1% 2% 1% 1% 1% 1%
PB cat 2 5% 5% 7% 6% 5% 7% 7% 4% 6% 7% 6% 7% 4% 6%3 1% 2% 1% 1% 2% 1% 2% 1% 1% 1% 1% 1% 1% 1%4 2% 1% 3% 3% 1% 3% 3% 3% 3% 3% 3% 3% 1% 1%
5A 1% 1% 0% 1% 1% 1% 1% 0% 1% 2% 1% 0% 0% 1%5B 1% 1% 3% 2% 4% 2% 2% 3% 2% 3% 2% 2% 0% 0%5C 3% 4% 0% 1% 0% 1% 1% 3% 4% 3% 3% 3% 0% 0%5D 1% 1% 1% 1% 1% 0% 1% 0% 1% 1% 1% 1% 1% 1%5X 5% 6% 7% 7% 14% 6% 7% 7% 5% 4% 7% 4% 7% 13%
6 4% 1% 5% 5% 9% 3% 8% 3% 6% 4% 4% 3% 5% 3%7 3% 3% 4% 4% 3% 5% 4% 4% 4% 4% 5% 3% 3% 2%8 2% 3% 2% 2% 2% 2% 2% 2% 2% 2% 2% 1% 1% 3%9 0% 1% 0% 0% 0% 0% 1% 0% 1% 1% 0% 0% 0% 0%
10A 4% 3% 3% 3% 1% 3% 4% 3% 3% 3% 3% 4% 1% 2%10B 1% 1% 1% 1% 1% 1% 2% 1% 2% 2% 1% 1% 1% 0%10C 1% 0% 0% 0% 0% 1% 1% 0% 1% 1% 1% 0% 0% 0%10X 4% 4% 5% 5% 2% 4% 4% 4% 4% 4% 4% 4% 2% 3%11A 1% 1% 1% 1% 0% 1% 1% 1% 1% 1% 1% 0% 1% 0%11B 1% 1% 1% 1% 0% 1% 1% 2% 1% 1% 1% 1% 0% 0%11X 3% 3% 2% 3% 2% 2% 3% 3% 2% 2% 3% 3% 2% 3%
12 3% 4% 5% 4% 4% 5% 4% 1% 4% 5% 5% 4% 6% 4%13 5% 4% 5% 5% 4% 5% 5% 7% 5% 5% 6% 5% 4% 5%14 1% 2% 2% 2% 2% 4% 2% 2% 2% 2% 2% 2% 3% 2%15 5% 6% 4% 4% 4% 5% 5% 4% 4% 6% 4% 4% 5% 5%16 3% 3% 4% 4% 4% 5% 4% 3% 4% 4% 5% 4% 3% 4%
17A 1% 1% 1% 1% 2% 1% 1% 2% 1% 1% 1% 2% 2% 2%17B 1% 2% 2% 1% 1% 2% 2% 1% 1% 1% 1% 1% 2% 2%17C 0% 1% 0% 0% 1% 1% 0% 0% 0% 0% 0% 0% 1% 0%17X 1% 2% 2% 1% 1% 1% 1% 2% 1% 2% 2% 2% 1% 4%
18 5% 4% 5% 5% 4% 5% 4% 11% 3% 5% 4% 3% 5% 7%19 1% 2% 1% 1% 2% 1% 1% 0% 1% 0% 0% 1% 1% 1%20 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1%21 2% 7% 2% 22% 3% 1% 2% 1% 2% 2% 2% 2% 0% 2%22 16% 2% 21% 0% 2% 1% 1% 1% 1% 1% 2% 1% 2% 2%
23A 9% 15% 0% 0% 11% 12% 10% 14% 11% 11% 13% 12% 15% 12%23B 0% 1% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%23X 0% 1% 0% 0% 2% 5% 3% 3% 8% 3% 4% 13% 18% 7%
Balanced score card approach
Key findings from analysis were considered along side your strategic goals and initiatives to identify key areas for market development
Options and actions for market development in these areas are set out in your Road Map
6 Options
Balanced score card5 Market development options6
Road maps7
Health Market Analysis
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Attributes Needed to Sustain Health Market Analysis in Norfolk
Market analysis is not a “one off” project, constant analysis and evaluation is crucial for long term success
?What skills, capabilities and enablers are needed to take health market analysis and
market development forward?
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Key Findings for Norfolk
Section 4
The Balanced Scorecard: Key Findings
•Service segments corresponding to the 23 budget categories have been prioritized in a balanced scorecard
•The scorecard’s four criteria are
- Demand forecast
- Service analysis
- Market structure
- Norfolk PCT’s strategy, vision and objectives
•The top five priority areas for market development have been identified
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The Balanced Scorecard: Key Findings
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The five key market development opportunities for Norfolk PCT that have emerged directly from analysis undertaken as part of the HMA project are:
1.Stimulate competition in community based Coronary Heart Disease services
2. Introduce additional dental service providers
3. Performance management and indirect competition in cancer services
4. Deliver more maternity service outside of the acute setting
5. Improve contracting for trauma and injuries
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Check and Challenge Discussions and Conclusions
Section 5
Check and Challenge Discussions
?• Do you recognise this as a market development priority?
• What are the key issues with this service? Quality? Demand?
• How does developing this market support your strategy?
• What may be the next market development steps?
• What is the key area for market development to take forward into action planning during the next workshop?
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Key discussion stimuli
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Introducing a methodology for market definition and market development
Section 6
•A market is defined as…
…any space in which the sellers of a particular good or service can meet with the buyers of that good or service and there is a potential for a transaction to take place
•Any healthcare market can be split into a number of care pathways
•A number of stages of care occur along each care pathway
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What do we mean by a market?
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Columns: Porter pathway stages
Row
s: b
ased
on
patie
nts’
nee
ds
Prevention Diagnosis Preparation Intervention Rehabilitation
Long term care /
management / monitoring
Total Pathway
I
II
III
IV
V
A potential market segmentation: a framework for lateral thinking within health
Lateral thinking within health
?• How does lateral thinking support market development and strategic
commissioning?
• Do you think about health service markets in this way?
• What do you know about the health service market that could help build up a lateral picture of health services?
• What are the information gaps of challenges for lateral thinking about health service markets?
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What to Expect from Workshop Two
Section 7
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Overview of Workshop 2
Step 1:Key findings from health market
analysis
Defining the need for change
Output 1:Pathway heat map and identification of a
market “hotspot”
Step 2:Additional local analysis and
experience
In workshop 2 we will use the market segmentation framework to better define the market and the need for change, building up a ‘pathway heat map’ based on market analysis and local experience.
Prevention
Diagnosis
Preparation
Intervention
Rehabilitation
Long term care /
management /
monitoring
Total Pathway
I
II
III
IV
V
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Overview of Workshop 2
With a well defined understanding of the need for change we will work through the steps for developing what the future for the service should look like and the key steps for making it happen
Defining the need for change
Developing the future requirement
Implementing the change plan
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Conclusions and Feedback
Section 8
Market Analysis Workshop One: Your Feedback on Today’s Session
•What went well?
•What didn’t go well?
•What would you change and why?
•What are your expectations for the next working session?
•Any additional comments
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