norfolk pct wcc health market analysis workshop 1

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


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

3PricewaterhouseCoopers LLP December 2008Strictly Confidential

Agenda


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


•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


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


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


?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?


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


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





Demand models2

Supply analysis3

Market analysis4

Balanced score card5 Market development options6

Road maps7


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


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


-

1 Taxonomy


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


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


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


2 Demand forecasts

3 Service analysis

5 Priorities

6 Options

7 Road map


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1 Taxonomy


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


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


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


2 Demand forecasts

3 Service analysis

5 Priorities

7 Road map

Service quality analysis


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






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





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



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


The Balanced Scorecard: Key Findings


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?


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


What do we mean by a market?


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


This publication has been prepared for general guidance on matters of interest only, and does not constitute professional advice. You should not act upon the information contained in this publication without obtaining specific professional advice. No representation or warranty (express or implied) is given as to the accuracy or completeness of the information contained in this publication, and, to the extent permitted by law, PricewaterhouseCoopers LLP, its members, employees and agents do not accept or assume any liability, responsibility or duty of care for any consequences of you or anyone else acting, or refraining to act, in reliance on the information contained in this publication or for any decision based on it.

© 2008 PricewaterhouseCoopers LLP. All rights reserved. 'PricewaterhouseCoopers' refers to PricewaterhouseCoopers LLP (a limited liability partnership in the United Kingdom) or, as the context requires, the PricewaterhouseCoopers global network or other member firms of the network, each of which is a separate and independent legal entity.

norfolk pct wcc health market analysis workshop 1

Documents

norfolk market analysis

market analysis skills

health market analysis

market segments

health market outline

current market analysis

service analysis

supply analysis