measuring cost and impact
DESCRIPTION
Measuring Cost and Impact. Nick Hex Project Director 28 March 2012. Understanding the economics – why is it important?. Importance of cost effectiveness in decision-making; Changing commissioning landscape; Funding restrictions – QIPP; NHS Outcomes Framework. Increasing survivorship. - PowerPoint PPT PresentationTRANSCRIPT
Measuring Cost and Impact
Nick Hex
Project Director
28 March 2012
Understanding the economics – why is it important?
• Importance of cost effectiveness in decision-making;
• Changing commissioning landscape;• Funding restrictions – QIPP;• NHS Outcomes Framework.
Increasing survivorship
0 5 10 15 20 25 30 35 400%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%1996-2000 1991-1995 1986-1990 1981-1985 1976-1980 1971-1975 1966-1970
Years since diagnosis
% s
till a
live
Economic costing
• February – October 2011:• Models of the costs of different approaches to
survivorship;• Based on activity and costs at 4 pilot sites;• Proxy costs and assumptions used.
Economic costing
• Key findings:• The costs of LTFU care costs in secondary care
have been reduced by risk stratification of patients
• New models of care increase capacity to provide care for more survivors;
• But good practice models of care may require additional costs.
Economic modelling
Objectives
• Our remit:• Identify additional variables that will influence the cost
of the new pathways and describe the effects of these;• Produce a more detailed model of costs for a LTFU
service;• Develop the costing methodology into a model which
can be easily used by commissioners and care providers to understand the costs of survivorship.
Additional cost factors
• Implementation and start-up costs;• Quality improvements, eg, care
coordinators, transition clinics etc;• Services outside the acute sector.
Literature review
• Very little data or published studies;• Costs, but no activity, for primary care;• Services outside the acute sector do not
have negative impacts on patient care.
Economic modelling: inputs
Staffing activityClinical
staffNurses Support
Outpatient clinics
Nurse-led clinics
Telephone follow-ups
Virtual review
Economic modelling: inputs
• Investigation costs;• Quality additions;• Additional primary care visits:
• GP time;• Investigations.
• Tariff income.
Costing scenarios
1. Costs of treating 900 survivors with and without risk stratification;
2. The effect on the commissioning body and the hospital provider of changing service provision, ie. the impact of changing tariff income
Scenario 1: hospital costs
Non risk-stratified service
Numbers £
All patients 900 340,000
Risk-stratified service
Numbers £
Level 1 75 16,000
Level 2 550 178,000
Level 3 275 108,000
TOTAL 302,000
Scenario 2: tariff impact
Non-risk stratified service Risk-stratified service
Hospital cost £340,000 £302,000
Additional primary care cost
- £32,000
Total £340,000 £334,000
Tariff payment £315,000 £228,000
Shortfall to provider £25,000 £74,000
In summary
• Costing model indicates that hospitals may reduce costs through risk stratification but tariff income may also be reduced;
• Commissioners likely to incur additional primary care costs;
• More research needed around outcomes and the provision of services outside of secondary care;
Next steps
• Finalise model and issue for consultation, along with a user guide;
• Develop further scenarios;• Draft report for NHS Improvement/NCSI.
