Commissioners will behave in new ways. They will set outcomes for population groups that provider organisations need to work together to achieve. This will require strong performance management information to monitor new ways of working. They will also share financial risks with providers through a capitated payment model. This type of reimbursement system requires detailed understanding of activity and costs at an individual level right across a system in order to:
- Segment and analyse current population outcomes and costs to identify a starting point
- Calculate capitated budgets for population groups
- Track individual outcomes and costs to monitor performance and identify emerging financial risks
The exhibit below summarises the key behaviours and activities commissioners will need to take to establish Whole Systems Integrated Care, and then considers the supporting information needed.
What tools are needed for commissioners?
As for service users, many information needs for commissioners require a comprehensive data set, integrating input from the various provider systems. As discussed before, the Whole Systems Data Warehouse will address this issue.
The following tools are also needed:
Population analytics. To play their role effectively, commissioners will need to have a thorough understanding of the needs and activity of their population as well as of the costs associated with it.
Segmentation capability. Part of having a good understanding of a population is to have an effective approach to group the population, potentially commissioning care for specific groups separately. The commissioners will therefore need to be able to segment their population, adjust the approach and understand needs, activity, outcomes and costs for each group they generate.
Payment calculation capability. To ensure that the system gets the best value in care delivery and is sustainable in the long-term and that providers will have the right incentives, commissioners will have to determine a payment model and calculate accurately how much to pay each provider (network) they are working with. Moreover, they will need to define parameters that might trigger adjustments to the payment and have a way to re-calculate what providers should receive.
Performance analytics. Commissioners will need to be able to monitor the performance of the provider (network) they select to care for their population. In particular, they will want to monitor the outcomes delivered as well as other parameters, especially if they factor into the payment calculation and adjustments.