leeds ltc year of care commissioning early implementer site visit 7 th may 2015

Leeds LTC Year of Care Commissioning

Early Implementer Site Visit

7th May 2015

Leeds Year of Care EI Pilot Journey to Date

Tricia Cable

Overview

2012 to 14

• Leeds PCT selected as an Early Implementer • Project structure established within citywide Integration Programme • Initial steps in establishment of Integrated Community Health and Social Care Teams, Risk Stratification &

Leeds Care Record • Selection of 550 sample and analysis of 2012/13 data

2014/15

• Analysis of 2013/14 data for 550 sample• RRR Audit • Established NT , further developments of model • Leeds Care Record • Review of Transformation programme & YOC EI Pilot in light of context and policy & planning developments. • Redefine project

Improve health outcomes and cost effectiveness for a specific population by: Using an approach of population health with a clearly defined cohort with- delivery based on integrated multidisciplinary community based care, with robust

care planning and co-ordination with- care planned, delivered and managed by a new provider to provider partnership

arrangements with joint accountability for outcomes and - new financial arrangements based on forms of a capitated budget/pooled budget

and - new payment mechanisms and financial flows, if required.

Leeds YoC EI Commissioning pilot

Year 1 and 2

• Initially based on risk stratification • Cohort of 550 patients • 180 managed within NTs others from risk stratification • Single Leeds cohort • Cohort for building of capitated budget • Small number of ‘case study’ approach • RRR Audit.

Patient Cohort

Year 3 and 4Locally agreed by CCG based on:

• Analysis of whole population dataset by age, risk, frailty, LTCs • Detailed review of multimorbidity and co-morbidity • Service utilisation• Cost • Disease prevalence • Outcomes – ability to manage own condition, quality of life, PYLL • Clinical views • Published evidence • Size of cohort required for pilot • Practice lists• NT configuration.

Patient Cohort

Years 1 and 2 For YoC long term conditions cohort • To include Health & Social care spend • Activity and spend 2012/13 & 2013/14, 550 patients• Currency categories by risk category • In depth analysis on small sample of patients • Recovery, Reablement, Rehabilitation, (RRR) audit linked to tariff

flexibilities • Data availability and data sharing issues.

Capitated Budget

Years 3 and 4 • Activity & spend analysis 2014/15 – all patients with 1 or more LTCs • Estimated capitated budget and currency categories • Sense check against contract values • Shadow tracking throughout 2015/16 • Improved information & data development • Refinement of budgets • Modelling of Transformation workstream impacts • Development of Risk and Reward Agreement • Provider Impact modelling • Agreement of Payment mechanisms and financial flows.

Capitated Budget

Years 1 and 2 • Development of Neighbourhood Teams (national visit) • Risk Stratification • Leeds Care Record • Data sharing • Transformation Portfolio Programme- Integrated Care &

Prevention• Integration Pioneer.

Integration

Year 3 – Local Local Developments 2014/15:• Next stage development of NTs• CCGs Primary Care at scale development • Integration between NTs and Primary Care • BCF • Whole population pseudonymised data set • Review of YoC EI approach

Integration

Year 3 – National

• Year 3 National YoC EI programme – Shadow year • Information Governance issues • Integration Pioneer support programme – new provider

organisational forms – ACOs, lead provider etc.• Flexibilities – tariff • Personalisation & personal budgets • Financial future• 5 year Forward View • Models of Care - Vanguard

Integration



7th May 2015

Information Presentation

Tom Mason

Multimorbidity/Comorbidityanalysis for cohort identification

Leeds citywide prevalence of individual long term conditions

Hypert

ensio

n

Depres

sion

Asthma

Lipid_M

etabolism

_Diso

rders

Diabete

s

Cancer IHD

Hypothro

idism

Renal_

Failu

re

Cardiac

_Arrh

ythmia

Epile

psyCOPD

Heart

Failu

re

Osteoporo

sis

Cerebro

vascu

lar_D

isease

Periphera

l_Vasc

ular_D

isease

Schizo

phrenia

Demen

tia_an

d_Deli

rium

Chronic_

Liver_

Disease

Rheumato

id_Arth

ritis

Bipolar_D

isord

er

Parkinso

ns

Multiple_Scl

erosis

Chronic_

Pancre

atitis

0

55000

110000

Leeds citywide prevalence of individual long term conditions

0

55000

110000

Leeds City Wide Condition Categories

This chart shows the number of patients with long term conditions categories (based on the Scottish List … with some additions) The most common conditions in these groups are hypertension, depression, respiratory and coronary heart disease

0

10000

20000

18-34 35-44 45-54 55-64 65-69 70-74 75-79 80-84 85+

Leeds CIty Wide Number of Patients with Long Term Health Conditions By Age Group

Leeds North CCG

Leeds S&E CCG

Leeds West CCG

This chart shows the age breakdown by CCG of patients with one of more LTCs (excluding Asthma as a single condition where there are high figures for younger adults Asthma is included where it is in conjunction with another i.e. COPD)

Number of people with LTC’s (one or more), by age group, split by individual CCG

Prevalence of individual long term conditions Leeds North CCG

Total number of patients in cohort: 42,049 Total costs: £49,297,614

Cost per patient: £1,172



Prevalence of individual long term conditionsLeeds West CCG



Prevalence of individual long term conditionsLeeds South & East CCG

Number of Long Term Conditions with costs

0.0

2.5

5.0

18-34 35-44 45-54 55-64 65-69 70-74 75-79 80-84 85+

Leeds CIty Wide Average Number of Long Term Health Conditions By Age Group

Leeds North CCG

Leeds S&E CCG

Leeds West CCG

Average number of LTC’s, by age group, split by individual CCG

For each CCG:• Investigate combinations of LTC’s within agreed categories i.e.

2/3/4/5 LTC’s based on data and published evidence• Investigate links between multimorbidity/comorbidity with age,

frailty and cost• Each analysis by practice and Neighbourhood Team (NT)

Further analysis

Capitated Budgets

This chart shows average costs for Leeds patients with one or more long term condition. Community and Mental Health figures are indicative as they do not include all services. Adult social care costs are not included

Leeds Citywide average costs for patients with one or more LTC, by service

Adult Social Care (ASC) Cohort Long Term Conditions by Age Group

This chart shows the Leeds patients (split by age range and number of conditions) with one or more LTC by CCG in receipt of an ASC service

Total cost and average cost per patient, by CCG

Leeds North Leeds West Leeds South & East1,120

1,140

1,160

1,180

1,200

1,220

1,240

1,260

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

Total costs (£)Average costs, per patient (£)

£

• Adult Social Care costs will be added• Agreement of inclusions and exclusions• Reconciliation of costs by service in the data with the payments

that commissioners actually make• Evaluate the difference between tariff and provider costs• Shadow monitoring from 1st April 2015 data for full cohort (each

CCG pilot shadow monitoring to be introduced)

Next steps



7th May 2015

Data Sharing and Data Linkage

Leeds Care Record & CareTrak

Alastair Cartwright


Contribute

Consume

GPs98/108

LYPFT NTs2/13

LTHT LCH

ASC

GPs98/108

LTHT LYPFT

LTHT

Leeds Care Record

Data Processing Agreements

Data Sharing Agreements

Primary Use Secondary use


Secondary use

DSCRODMIC

Contribute

Consume

GPs LYPFT SUS LCHASC

Data Processing /Deposit Agreements

LTHTYAS

CCGs ASC

Pseudonymise +

Link

Integrated Dashboard + CareTrak

‘Transformation’ portfolios and providers

Inform

ASH / CCG


Challenges Challenges


Contribute

Consume

GPs98/108

LYPFT NTs2/13

LTHT LCH

ASC

GPs98/108

LTHT LYPFT

LTHT

Leeds Care Record




DSCRODMIC

Contribute

Consume



LTHTYAS

CCGs ASC

Pseudonymise +

Link



Inform

ASH / CCGCohortCohort

Re-identification for direct care purposes


Contribute

Consume

GPs98/108

LYPFT NTs2/13

LTHT LCH

ASC

GPs98/108

LTHT LYPFT

LTHT

Leeds Care Record




DSCRODMIC

Contribute

Consume



LTHTYAS

CCGs ASC

Pseudonymise +

Link



Inform

ASH / CCGCohortCohort

Re-identification for direct care purposes Patient opt-out via care.data


End! End!



7th May 2015

Leeds YoC CCG Pilots

Tricia Cable

• The characteristics of the YoC pilot are completely consistent with the 5 year Forward View and MCP characteristics

• Local primary care development & primary care relationships with NTs are fundamental to development of MCPs

• YoC pilots will enable each CCG to test some of the characteristics, assumptions, questions, to inform the full development of primary care at scale and MCPs

• YoC pilots can test at local CCG level whilst models of care for city are discussed with providers

• By delivering 3 pilots different characteristics may be tested • An overall Leeds YoC EI project will bring together the learning from each

pilot site for the benefit of the Leeds Health and Social Care economy.

Review of YoC EI approach

Primary care strategy

Models of care

development

YoC pilot

• Cohorts for NHS Leeds North CCG and NHS Leeds South & East CCG selected on basis of whole population dataset analysis - size?

• Cohort for NHS Leeds West CCG currently based on potentially identified pilot practice – all registered over 75 and care home residents, 700 – 800 patients

• Footprint to be selected based on cohort size, local practice joint working relationships, NT footprint, other CCG specific criteria e.g. PYLL – North Locality, South and East group of practices as subset of Federation, West – large single practice

• Agreement of pilot delivery model with partners in each pilot to be based on principles and characteristics of an MCP

• Agreement of pilot funding and timescale.

Draft Pilot Framework proposal

• Agreement of providers in partnership- 1) West single GP practice, Leeds Community Health, Leeds City Council Adult Social Care, LW CCG, 2)? S&E Federation, LCH, ASC, LYPFT, LTHT, LS&E CCG

• Development of Partnership Agreement e.g. devolved decision making • Multilateral gain/loss share • Agreement of use of a capitated budget, pooled budget or other financial

arrangements. Shadow monitor capitated budget from 1 April 2015• Specific pilot Evaluation.

Draft Pilot Framework proposal

• Leeds based • Central co-ordination • Links with national team • Responsible for ensuring maximum impact and value of 3 pilot

approach • Integration with ICP programme • Overall project management, reporting etc. • Engagement and communication across pilots• Support to local pilot leads and project teams • Evaluation.

National YoC EI Arrangements



7th May 2015

leeds ltc year of care commissioning early implementer site visit 7 th may 2015

Documents

integration slide

capitated budget slide

patient cohort slide

health social care

risk stratification

project slide

social care teams

primary care bcf