The most important decision affecting resource allocation, performance management and risk and saving sharing is the model of care. After agreeing decision-making processes the provider network must agree how they will organise interventions to achieve desired outcome for their population. Detailed information about this process is in Chapter 6: How do we innovate a new model of care working with users and carers?
In summary, the provider network will be set desired outcomes by commissioners for a population group and have a capitated budget it can use to achieve these outcomes. The providers in the network must work together to identify:
- Interventions that will support population to achieve desired outcomes
- Service standards against which the effectiveness and quality of interventions and those who conduct them will be measured. These standards are very important because they inform the provider network performance management framework and risk and savings sharing discussed in the next section.An example list of performance metrics can be found in the Supporting Material A: Discussion Paper Compendium.
- Resources required to fund the service standards that support new model of care. Details of how to achieve this are in Chapter 6: How do we innovate a new model of care working with users and carers?
The total of all these budgeted costs must be less than the capitated budget paid to the provider network. Provider networks will need to revisit the model of care until they can agree how to achieve the outcomes within the target budget. For a full discussion of how to approach costing models of care see Chapter 6: How do we innovate a new model of care working with users and carers? In addition to funding the service standards, provider networks should also decide allocations for:
- Personal budgets: When capitated payments include social-care personal budgets, provider networks will need to meet the statutory obligations set out in the Fair Access to Care Services guidance (FACS), which require local authorities to provide individuals with a defined level of support. In addition to the statutory obligations, provider networks may also want to provide personal budgets to other individuals as they represent a cost effective way of personalising care that keeps people well.
- Internal contingency funds: Provider networks will want to retain a contingency fund that can be used for unanticipated interventions above the agreed model of care. This will support agility and personalisation of care. It also reduces the risk that providers will overspend the capitated budget
- Operations team: Providers networks may fund a shared operations team to manage the coordination of member organisations, lead performance management and administer the network.
Once the model of care, service standards and resources are agreed, the provider network needs to identify the multi-disciplinary team and where the staff with the relevant skills needed are (or could be retrained or hired) across member providers. Determining which staff will do what will determine how resources are allocated between providers within the network. Following this process will mean that funding flows to where it is needed to support new model of care.