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- 1. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 1141211_Allocation Decision Han ...LONThis information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent Decision Handbook A reference guide for making effective transformation programme decisions
- 2. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 2141211_Allocation Decision Han ...LON Why focus on decisions? • Devolved authority, matrixed accountability and divergent incentives in the NHS produce impasses, inefficient process and sub-optimal results Situation Complication A focus on decisions can cut through this complexity Resolution • A new approach that moves beyond org structure is needed to deliver the best possible value for patient and public • Demand for health services is growing faster than funding • There is consensus that the health service must deliver better value
- 3. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 3141211_Allocation Decision Han ...LON The purpose of the handbook is to… Help the health service deliver better value for patients and public Guide effective decision making across all organisations Support Finance as leaders in driving robust value-based decision making
- 4. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 4141211_Allocation Decision Han ...LON What the handbook is and is not Framework and approach for managing and making value-based decisions Guide on what to consider, who to involve and the process to follow Single source for tools, templates and data helpful for each step Tool to structure analysis or build a business case Guide to negotiating with stakeholders Methodology to evaluate results after a decision has been made WHAT IT IS WHAT IT IS NOT
- 5. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 5141211_Allocation Decision Han ...LON Who the handbook is for It is useful for everyone involved in the process of making decisions that impact value: • For those who make and coordinate decisions it provides a rigorous and structured end-to-end process to drive value-based decision making • For those who have a key input role and make recommendations it provides clarity on the big picture and helps guide the evaluation process • For those who provide input and analysis it provides context on the overall process and links to tools, templates and data to help them input HELPFUL HINT Click on the symbols throughout the handbook to jump to resources and tools related to the topic
- 6. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 6141211_Allocation Decision Han ...LON How to use this handbook CFO / Finance Director Deputy Finance Director Finance Manager Chief Executive Commissioning / Transformation Director Commissioning/ Transformation Head Before your decision process starts • Review and understand the NHS approach , “What is value” and big picture • Scan the appendix for helpful tools, data sources and resources As you move through the decision process • Focus on the role of finance to understand where you should be inputting • Reference the “how” when starting each step for awareness of all moving parts Before your decision process starts • Study the NHS approach section closely • Adapt the example decision set-up, roles and timeline to your situation • Review and sense-check the high-level role of finance, use it as your guiding star As you move through the decision process • Reference the “how” as you start each step (x4) to ensure critical pieces aren’t missed • Refer your direct reports and colleagues to relevant tools in the appendix Most people won’t find reading the guide beginning-to-end an efficient use of time. Depending on your role, we recommend focusing on different sections. If you are a… • Review and discuss the “What is value” with colleagues to see how you can integrate non-finance elements of value into your analysis • Scan the appendix for helpful tools, data sources and resources Then you should…..
- 7. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 7141211_Allocation Decision Han ...LON • “What, who, how and when” - setting the decision up for success • “How” - deeper look at critical elements for each step in the process • Role of finance - key actions, analysis, data and tools for finance Contents APPROACH DECISION HANDBOOK APPENDIX • NHS approach to effective decision making • An holistic definition of value • Data sources and links • Data tools and links • Star modelling tool for value-for-money analysis • AID model for QIPP prioritisation • Stakeholder map and public engagement tool • Programme budgeting marginal analysis • Integrated Risk and Impact Assessment Tool • Decision Trees • Full Business Case template APPROACH DECISION HANDBOOK APPENDIX TIP: Click on any of the text below to skip to that section
- 8. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 8141211_Allocation Decision Han ...LON Setting up decisions for success requires focus on the “what- who-how-when” • Define the decision we are actually trying to make • Frame the decision in an appropriate way • Split into sub-decisions if necessary What • Clarify upfront who will play what role in each decision (e.g. decision-maker, recommender) Who • Install structured decision approach • Design and specify: - Interactions - Critical meetings/committees - Closure and commitment - Feedback loops HowWhen • Clarify timeline for decision and execution, and key milestones • Consider creating a decision calendar for on-going, interconnected decisions 1 2 4 3 APPROACH DECISION HANDBOOK APPENDIX
- 9. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 9141211_Allocation Decision Han ...LON What Who HowWhen What Who HowWhen • Clarify exactly what decision is under consideration: -Make sure everyone is on the same page regarding how to define the decision being made -Frame the decision correctly so participants can make appropriate tradeoffs -Unbundle the decision into its sub-decisions before working through next steps Defining the decision The “What”: Clear and correct definition of the decision and its sub-decisions APPROACH DECISION HANDBOOK APPENDIX
- 10. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 10141211_Allocation Decision Han ...LON What Who HowWhen The “Who”: The RAPID® framework provides a simple tool for allocating decision roles Perform a decision once made Recommend a decision or action Formally agree a recommendation • Must be consulted • Must work with R to resolve issues Provide input to a recommendation • Must be consulted, may or may not be reflected in final view Input Input Input Recommend Decide Perform Agree RAPID should reflect what will work in 90% of situations WHAT THE ROLES ARE HOW THE ROLES INTERACT Make a final decision and commit the organisation to action Recommend Agree Perform Input Decide ® RAPID is a registered trademark of Bain & Company, Inc. APPROACH DECISION HANDBOOK APPENDIX
- 11. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 11141211_Allocation Decision Han ...LON The “Who”: RAPID® roles imply a set of responsibilities Recommend Agree Perform Input Decide • Only one R – person who does 80% of the work to develop recommendation • R has broad visibility and access to information for relevant inputs • R has credibility with both Is and D • Like an Input “with teeth” – must be factored into the recommendation • Must work with R to resolve any issues • A is on the R – D breaks a deadlock • May be multiple Ps • May involve P as an I to help upfront planning • Can be multiple Is, but must be consulted, may or may not be reflected in final view • Assigned only to those with valuable information which could change the decision • Only one D for each decision • Locate the D at the right level in the organisation (access to information, reaction times, ability to make tradeoffs • If D belongs to a group, clarify how it gets exercised TIPS & TRICKS What Who HowWhen ® RAPID is a registered trademark of Bain & Company, Inc. APPROACH DECISION HANDBOOK APPENDIX
- 12. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 12141211_Allocation Decision Han ...LON The “How”: Combination of the right people and information in the right sequence to make decisions • We are clear which facts and evidence need to underpin decisions; working from one version of the truth for decision inputs • Necessary pre-decision steps Critical steps • Once a decision is made, we move swiftly to launch execution - Resources allocated (people and money) - Execution plan in place (actions, accountabilities and milestones) - Feedback loops in place to drive fast corrective action or replicate successes Closure • We ensure we consider the full range of alternatives • We evaluate alternatives vs. agreed criteria using rigorous data and analysis Choices • We establish clear criteria for how we will evaluate options / make decisionCriteria DECISION • We clearly communicate decisions once made to all relevant stakeholdersCommunication • We make effective use of committees and meetings throughout the decision processCommittees Pre-decisionPost-decision What Who HowWhen APPROACH DECISION HANDBOOK APPENDIX
- 13. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 13141211_Allocation Decision Han ...LON The “When”: Clarification of the timing for the programme and each sub-decision before the process starts What Who HowWhen For illustration APPROACH DECISION HANDBOOK APPENDIX
- 14. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 14141211_Allocation Decision Han ...LON • “What, who, how and when” - setting the decision up for success • “How” - deeper look at critical elements for each step in the process • Role of finance - key actions, analysis, data and tools for finance Contents APPROACH DECISION HANDBOOK APPENDIX • NHS approach to effective decision making • An holistic definition of value • Data sources and links • Data tools and links • Star modelling tool for value-for-money analysis • AID model for QIPP prioritisation • Stakeholder map and public engagement tool • Programme budgeting marginal analysis • Integrated Risk and Impact Assessment Tool • Decision Trees • Full Business Case template APPROACH DECISION HANDBOOK APPENDIX TIP: Click on any of the text below to skip to that section
- 15. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 15141211_Allocation Decision Han ...LON Making a value-based decision requires a definition of value and its components Value Clinical outcome e.g. population health, survival rate, extent of functional recovery Patient experience e.g. comfort, treatment by staff, waiting time, ease of access Safety e.g. diagnostic error, post-op complications, infections Revenue costs e.g. income, time, salaries, system maintenance, facilities Capital costs e.g. Investment in infrastructure / equipment Outcomes Resources 1 2 3 4 5 Source: based on Michael Porter (HBR, NEJM), HFMA “Value in Health Care”, Delivery Group interviews Value can be increased by improving outcomes for a given resource level or by reducing the resource required to deliver a given outcome APPROACH DECISION HANDBOOK APPENDIX
- 16. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 16141211_Allocation Decision Han ...LON Criteria and metrics within each component of value must be defined depending on the specific decision Outcomes Clinical outcome • Population health • Outcome of interventions relative to patient expectations • Degree and speed of recovery • Sustainability of health • … • Prevalence of conditions within population • Hospital / emergency admission rate • Quality of recovery (e.g. visual ability post-Cataract op) • Mortality rate • Re-admittance rate • … Patient experience • Ability to access care • Care environment (e.g. facilities, comfort) • Personal interactions (e.g. care and respect) • Timeliness of interactions • Availability of information • Involvement in decision-making • … • Distance to care facility • Waiting time for first appointment • Specialists per population • Time between referrals and number of referrals • Patient feedback on experience with interactions • Patient Net Promoter Score • … Safety • Diagnostic errors • Post-operative complications • Medication errors • … • Diagnostic error rate • Complication rate • Medication error rate • … Resources Revenue costs • People • Facilities • Equipment • .. • Income • Salaries • Time • System running costs Capital costs • Investment in facilities / equipment • … • Capital requirement and rate of return • … COMPONENTS OF VALUE CRITERIA (EXAMPLES) METRICS (EXAMPLES) 1 2 3 4 5 Source: based on Michael Porter (HBR, NEJM); HFMA “Value in Health Care”; Delivery Group interviews APPROACH DECISION HANDBOOK APPENDIX
- 17. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 17141211_Allocation Decision Han ...LON An holistic value definition must be embedded in the “what-who- how-when” to achieve best possible value in decision making Framing your decision context, objectives and constraints using a value perspective What Getting the right people engaged to ensure focus on system-wide value Who Taking the right steps, through the right process with the right analysis for an integrated value approach HowWhen Starting at the right time, with the right timetable and milestones to make considering and delivering better value possible 1 2 4 3 APPROACH DECISION HANDBOOK APPENDIX
- 18. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 18141211_Allocation Decision Han ...LON • “What, who, how and when” - setting the decision up for success • “How” - deeper look at critical elements for each step in the process • Role of finance - key actions, analysis, data and tools for finance Contents APPROACH DECISION HANDBOOK APPENDIX • NHS approach to effective decision making • An holistic definition of value • Data sources and links • Data tools and links • Star modelling tool for value-for-money analysis • AID model for QIPP prioritisation • Stakeholder map and public engagement tool • Programme budgeting marginal analysis • Integrated Risk and Impact Assessment Tool • Decision Trees • Full Business Case template APPROACH DECISION HANDBOOK APPENDIX TIP: Click on any of the text below to skip to that section
- 19. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 19141211_Allocation Decision Han ...LON How to read the pages in this section Decision roles (R-A-P-I-D) of all key players for each sub-decision “WHAT” - DECISION CHARTER “WHO” - DECISION ROLES “WHEN” – TIMELINE “HOW” – DECISION COMPONENTS What Who HowWhen What Who HowWhen What Who HowWhen What Who HowWhen APPROACH DECISION HANDBOOK APPENDIX A reasonable timeline for the decision process with key milestones A high-level summary of critical steps through the decision process Context, objectives and constraints set up the decision for success
- 20. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 20141211_Allocation Decision Han ...LON Decision roadmap: “what-who-how-when” • Define the decision we are actually trying to make • Frame the decision in an appropriate way • Split into sub-decisions if necessary What • Clarify upfront who will play what role in each decision (e.g. decision-maker, recommender) Who • Install structured decision approach • Design and specify: - Interactions - Critical meetings/ committees - Closure and commitment - Feedback loops HowWhen • Clarify timeline for decision and execution, and key milestones • Consider creating a decision calendar for on-going, interconnected decisions 1 2 4 3 APPROACH DECISION HANDBOOK APPENDIX
- 21. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 21141211_Allocation Decision Han ...LON The decision charter should be framed to emphasise system-wide value, including objectives and constraints Constraints Objectives Context • Improve value (cost, outcomes, safety and experience) delivered by the health system • Deliver services more efficiently to meet population’s health needs • Changes are sustainable within the broader health economy • Providers support and implement the changes • Must reduce projected outlays by £4M • Manage resources within the financial framework set by NHS England • Must align with CCG strategic plan and adhere to CCG governance rules • Must be acceptable to public/political officials and regulators • Should be acceptable to clinical staff, financial staff and patients NHS data indicate that a CCG responsible for a small northern industrial town of ~200,000 people is underperforming relative to its demographic peer group in several service areas. Their budget allocation will increase 5% next year to £210M, while projected outlays with no commissioning changes are expected to increase 7% to £214M. The CCG must decide how to improve value and bridge the £4M resource gap in the health economy, and ensure providers implement the necessary changes. Decide how to improve value and bridge a £4M resource gap in the health economyDecision What Who HowWhen APPROACH DECISION HANDBOOK APPENDIX
- 22. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 22141211_Allocation Decision Han ...LON Example value criteria and metrics for this decision should be adapted to match your decision context Outcomes Clinical outcome • Population health • Prevention • Outcome of intervention relative to patient expectations • Patient recovery • Sustainability of health • Prevalence (e.g. hypertension prevalence relative to peer group) • Prevention (e.g. ratio of hypertension v. heart failure prevalence, % of CHD patients on aspirin) • Diagnosis (e.g. % of cancers detected at an early stage) • % patients treated to a pre-defined care standard (e.g. 8 Key Care Processes for Diabetics) • Recovery (e.g. % of patients discharged home) • Survival rate (e.g. 1 year net cancer survival rate) • Re-admittance rate (e.g. emergency re-admission to hospital within 28 days (%): stroke) Patient experience • Access to care • Experience in care • Distance to care (e.g. average distance for emergency admission) • Waiting times (e.g. TIA cases treated within 24 hrs) • Specialists per population (e.g. proportion of non-STEMI patients seen by member of cardiology team) • Time between referrals (e.g. % of cancers receiving treatment within 2 months of GP referral) Safety • NRLS safety incidents by type (e.g. “clinical assessment” incidents compared to peer group) • Clinical assessment incidents • Treatment/procedure incidents • Medication incidents Resources Revenue costs • Delivery model / cost structure • Activity rates (e.g. imaging frequency) • Clinician salary • Admin staff salary • System running costs • Activity (total) • Total programme spend relative to peer group (e.g. spend on primary care prescribing for CHD) • Elective/Non-elective programme spend (e.g. spend on non-elective admissions for GI cancer) Capital costs • Investment in facilities / equipment • … • Capital requirement and rate of return • … COMPONENTS OF VALUE CRITERIA METRICS (EXAMPLES) 1 2 3 4 5 What Who HowWhen APPROACH DECISION HANDBOOK APPENDIX
- 23. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 23141211_Allocation Decision Han ...LON This CCG transformation programme decision has four key sub-decisions Decide whether to proceed with preferred option(s) and implementation plan Determine deliverability of preferred option(s) Determine how to improve each opportunity area and the preferred option(s) for improvement Determine areas with greatest opportunity for improved outcomes/cost reduction Closure How ToChange What ToChange Where ToLook Establish Charter 1 Set Up Execution NHS Right Care Approach Communicate To Stakeholders 4 2 3 Decision: Decide how to improve value and bridge a £4M resource gap in the health economy Define Key Criteria Define Roles Frame Decision Key sub-decision What Who HowWhen APPROACH DECISION HANDBOOK APPENDIX
- 24. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 24141211_Allocation Decision Han ...LON Decision roadmap: “what-who-how-when” • Define the decision we are actually trying to make • Frame the decision in an appropriate way • Split into sub-decisions if necessary What • Clarify upfront who will play what role in each decision (e.g. decision-maker, recommender) Who • Install structured decision approach • Design and specify: - Interactions - Critical meetings/ committees - Closure and commitment - Feedback loops HowWhen • Clarify timeline for decision and execution, and key milestones • Consider creating a decision calendar for on-going, interconnected decisions 1 2 4 3 APPROACH DECISION HANDBOOK APPENDIX
- 25. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 25141211_Allocation Decision Han ...LON RAPID® roles for this decision are designed to maximise decision effectiveness and can be adapted to your context Local Authority CCG Board CCG chief exec. officer CCG finance director or equivalent CCG commiss- oning director or equivalent Clinical Senate Council Health & Well-being Board Trust Board Trust finance director or equivalent Trust clinical directors or equivalent Consult- ants Clinical Experts Wider GP Comm- unity Regulat- ors Determine areas with greatest opportunity for improved outcomes/cost reduction D A R A I I Determine how to improve each opportunity area and the preferred option(s) for improvement D I R I I I A I Determine deliverability of preferred option(s) I D A R I A I Decide whether to proceed with preferred option(s) and implementation plan D R A I A P 2 3 4 R Recommend A Agree P Perform I Input D Decide What Who HowWhen 1 Decision: Decide how to improve value and bridge a £4M resource gap in the health economy P Ensuring stakeholders understand their RAPID® role up-front will improve efficiency, reduce impasses and improve decision quality APPROACH DECISION HANDBOOK APPENDIX Key sub-decision
- 26. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 26141211_Allocation Decision Han ...LON Sub-decision Role of Finance RAPID Intensity of Involvement Actions Determine areas with greatest opportunity for improved outcomes/cost reduction Drive integration of finance and outcome/quality analyses A • Generate a broad range of options for consideration • Translate activity and non-financial data into financial terms; share insights with CCG commissioning director Determine how to improve each opportunity area and the preferred option(s) for improvement Own rigorous analysis and insight generation I • Push for rigorous evidence and assumptions on financial and non-financial benefits • Assist integration of financial/non-financial analyses into cohesive value assessment Determine deliverability of preferred option(s) A • Identify, quantify and assign probabilities to resource based limiting factors, barriers and risks • Offer finance view on non-financial limiting factors, barriers and risks Decide whether to proceed with preferred option(s) and implementation plan Lead on delivering value R • Responsible for compiling full business case and presenting recommendation to the board • As board member, push to integrate financial/non- financial analyses into a unified assessment of value 2 3 4 1 What Who HowWhen The role of finance in this process changes across sub- decisions Key = High intensity = Medium intensity = Low intensity APPROACH DECISION HANDBOOK APPENDIX Key sub-decision
- 27. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 27141211_Allocation Decision Han ...LON Decision roadmap: “what-who-how-when” • Define the decision we are actually trying to make • Frame the decision in an appropriate way • Split into sub-decisions if necessary What • Clarify upfront who will play what role in each decision (e.g. decision-maker, recommender) Who • Install structured decision approach • Design and specify: - Interactions - Critical meetings/committees - Closure and commitment - Feedback loops HowWhen • Clarify timeline for decision and execution, and key milestones • Consider creating a decision calendar for on-going, interconnected decisions 1 2 4 3 APPROACH DECISION HANDBOOK APPENDIX
- 28. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 28141211_Allocation Decision Han ...LON Mapping the decision process supports proper sequencing and execution of all critical steps Agree terms with providers / market Seek agreement from Trust board and CCG finance on recommendation Input and agreement from Health & Wellbeing Board Closure How ToChange What ToChange Where ToLook Establish Charter Set Up Execution NHS Right Care Approach Assess wider system impact Appraise relative options Develop full business case including impact assessments Communicate To Stakeholders Define Key Criteria Define Roles Frame Decision Determine areas with greatest opportunity for improved outcomes/cost reduction Determine how to improve each opportunity area and the preferred option(s) for improvement Determine deliverability of preferred option(s) 4 Decide whether to proceed with preferred option(s) and implementation plan Define optimal service based on proven models Conduct Service Reviews 2 3 Align stake- holders on key criteria 1 Decision: Decide how to improve value and bridge a £4M resource gap in the health economy What Who HowWhen APPROACH DECISION HANDBOOK APPENDIX Key sub-decision Review JSNA Analyse benchmark data (e.g. Commiss- ioning for Value pack, SPOT, etc.) Assess baseline costs Review Risk Stratifi- cation Gather clinical and provider input Map resource use by population group Compile risk appraisal and mitigants Input from stakeholders (e.g. Health & Wellbeing Board)
- 29. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 29141211_Allocation Decision Han ...LON Decision roadmap: “what-who-how-when” • Define the decision we are actually trying to make • Frame the decision in an appropriate way • Split into sub-decisions if necessary What • Clarify upfront who will play what role in each decision (e.g. decision-maker, recommender) Who • Install structured decision approach • Design and specify: - Interactions - Critical meetings/ committees - Closure and commitment - Feedback loops HowWhen • Clarify timeline for decision and execution, and key milestones • Consider creating a decision calendar for on-going, interconnected decisions 1 2 4 3 APPROACH DECISION HANDBOOK APPENDIX
- 30. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 30141211_Allocation Decision Han ...LON What Who HowWhen Decision timeline of a ‘good case’ scenario Decision Calendar Mo1 Mo2 Mo3 Mo4 Mo5 Mo6 Mo7 Mo8 Mo9 Mo10 Determine areas with greatest opportunity for improved outcomes/cost reduction Announce commissioning Intentions / notice of desired changes Determine how to improve each opportunity area and the preferred option(s) for improvement Identify smaller quick-wins within the overall plan Identify larger scale transformative changes Determine deliverability of preferred option(s) Decide whether to proceed with preferred option(s) and implementation plan Announce implementation plan Sign new or amend existing contracts 1 2 3 4 Iterative process, misaligned incentives and behaviours can extend this process Closure HowTo Change What ToChange Where ToLook Decision: Decide how to improve value and bridge a £4M resource gap in the health economy APPROACH DECISION HANDBOOK APPENDIX Key sub-decision
- 31. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 31141211_Allocation Decision Han ...LON • “What, who, how and when” - setting the decision up for success • “How” - deeper look at critical elements for each step in the process • Role of finance - key actions, analysis, data and tools for finance Contents APPROACH DECISION HANDBOOK APPENDIX • NHS approach to effective decision making • An holistic definition of value • Data sources and links • Data tools and links • Star modelling tool for value-for-money analysis • AID model for QIPP prioritisation • Stakeholder map and public engagement tool • Programme budgeting marginal analysis • Integrated Risk and Impact Assessment Tool • Decision Trees • Full Business Case template APPROACH DECISION HANDBOOK APPENDIX TIP: Click on any of the text below to skip to that section
- 32. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 32141211_Allocation Decision Han ...LON Criteria Critical Steps Choices Considered Committees • Focus on areas where underperforming relative to demographic peer group clinically or financially • Focus on populations that consume the most resources • Seek to incorporate cost, quality, safety and experience considerations to deliver best possible value • Alignment with CCG long-term strategic priorities, JSNA and other key stakeholder priorities • Asset / facility utilisation • Map resource use by population group • Refresh/review risk stratification • Assess baseline costs • Analyse peer group, patient and provider benchmark data • Review Joint Strategic Needs Assessment, and long-term strategic priorities of CCG, stakeholders and Health & Wellbeing Board • Gather patient input • Programme/pathway budget allocations • Provider/care setting allocations • Contracting frameworks (e.g. payments linked to outcomes, lead provider arrangements, capitation) • Investment in self-managed care (e.g. web-accessible integrated digital care records) • Decommissioning services • Clinical Reference Group or equivalent: commissioning board sub-committee of clinicians - commissioning head gathers Input as needed • Transformation Stakeholder Working Group or equiv.: Joint provider / commissioner group - Input mechanism for Trust finance and Trust clinical heads • Health & Wellbeing Board: includes local authority, public health, Healthwatch, head of adult and children's social services reps - Commissioning head seeks Agreement. Recommendation must reflect views, even if dissenting CCG board CCG commissioning head CCG finance head Health & Wellbeing Board Trust finance head Trust clinical directors or equivalent Communication Closure • Send “influencing paper” with high-level case for change opportunities and forward view to commissioning, provider, patient and public stakeholders • Commissioning director or equivalent initiates programme/pathway review and stakeholder engagement through the Clinical Reference Group • CSU or internal business intelligence staff allocated for further analysis 2 3 41 What Who HowWhen Sub-Decision: Determine areas with greatest opportunity for improved outcomes/cost reduction Decision component snapshot for sub-decision one Click these icons throughout the Handbook for additional resources RD A A I I DECISION RAPID Roles APPROACH DECISION HANDBOOK APPENDIX
- 33. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 33141211_Allocation Decision Han ...LON Communication Closure • Commissioner submits clinical communication with rationale/preliminary case for change, including population health, to all clinical stakeholders • Commissioner submits a Letter of Commissioning Intention to: - Trust / Provider senior management - Other commissioners if joint commissioning • Commissioning and finance directors accelerate the viability assessment, reengaging provider finance and clinicians, regulators and patient groups • Clear competitive issues with regulators, and clinical issues with CQC • Finance / business intelligence staff are allocated for support Criteria Critical Steps Choices Considered Committees • Changes evaluated on their projected effect on cost, quality, safety and patient experience • Must be feasible to deliver within the required time horizon • Must not render other parts of the health and social care economy unsustainable (e.g. impact on specialist/NHS services, provider-level economics, etc.) • Best practice models preferred to those which are untested • Align stakeholders on criteria for evaluation • Conduct service reviews • Appraise relative options (expected outcome and benefit) • Assess wider system impact • Determine if public consultation is required • Contract Management (e.g. reducing outpatient follow up ratios to peer averages) • Policy Change: policies covering admissions, prescribing, etc. • Service or Pathway Redesign • Allocative (e.g. reallocate from child to elderly care, invest in prevention) • Provider/partner arrangements (e.g. retender) • Clinical Reference Group or equivalent: commissioning board sub-committee of clinicians - Commissioning head seeks Agreement from clinical experts - Recommendation to the CEO must convey views of expert clinicians, even if dissenting • Transformation Stakeholder Working Group or equiv.: Joint provider / commissioner reference group - Commissioning head seeks Input from consultants, GP, trust finance and trust clinical directors 2 3 41 What Who HowWhen Sub-Decision: Determine how to improve each opportunity area and the preferred option(s) for improvement Decision component snapshot for sub-decision two DECISION CCG chief executive CCG commissioning head Clinical experts CCG finance head Trust finance head Trust clinical directors Consultants Wider GP community RD A I I I I I APPROACH DECISION HANDBOOK APPENDIX RAPID Roles
- 34. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 34141211_Allocation Decision Han ...LON RAPID Roles Communication Closure • Submit/present deliverability assessment to: - CCG senior management - CCG Board - Co-commissioners (e.g. NHS if potential impact on specialist services) - Health & Wellbeing Board - Provider Boards • Commissioning finance director and non-finance staff begin assembling final recommendation including impact assessments • Finance staff are allocated to support the director in preparing final documents for submission to the board Criteria Critical Steps Choices Considered Committees • Simplicity is preferable to complexity • Level of provider support • Level of political / public support • Availability of resources to implement • Ability to sustain the change over multiple years • Funding should follow outcomes • Identify limiting factors (e.g. people, equipment, shortage of GP’s, insufficient number of trainers, etc.) • Identify potential barriers including: - Concerns of Local Authority - Financial impact on providers - Concerns of clinicians and expert patient groups • Compile risk appraisal including clinical, commercial, operational, implementation and timescale risks, scores and mitigants • Determine if programme will need regulatory approval • Proposal is deliverable / not deliverable • Parts of the proposal are deliverable • Parts are deliverable now, parts are deliverable later • Recommend modifications to proposal that make it more deliverable • Health & Wellbeing Board: includes local authority, public health, Healthwatch, head of adult and children's social services reps - Commissioning head seeks Input from Health & Wellbeing Board and Local Authority on her Recommendation to the CCG Board • CCG Board Decides based on commissioning head’s Recommendation 2 3 41 What Who HowWhen Sub-Decision: Determine deliverability of preferred option(s) Decision component snapshot for sub-decision three DECISION CCG Board CCG commissioning head CCG finance head Trust Board Local Authority Health & Wellbeing Board RegulatorsRD A I I IA APPROACH DECISION HANDBOOK APPENDIX
- 35. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 35141211_Allocation Decision Han ...LON RAPID Roles Communication Closure • Communicate full business case / case for change to: - CCG senior management - All market, regulatory and clinical stakeholders, especially trust senior management • Launch public/patient education programme • Memorandum of Understanding or equivalent is signed by providers and commissioner articulating the agreed changes • Changes to contracts made / process initiated • Commissioner and providers make joint public announcement • Develop plan to review and evaluate implementation Criteria Critical Steps Choices Considered Committees • Balance implementation risk and gain we expect to achieve • Seek to incorporate cost, quality, safety and experience to deliver best possible value • Alignment with CCG long-term strategic priorities, population needs defined by JSNA and other key stakeholder priorities • Focus on largest opportunities • Deliverability on a XX timescale • Develop full business case including: - Review impact assessments (equality & system) - Complete risk appraisal and mitigation steps - Stress test benefits realisation and cost assumptions - Compile implementation timescales, resources, milestones and measures of benefit - Develop potential exit strategy if the benefits don’t materialise - Determine board reporting requirements on implementation • Do nothing • Incremental change • Radical change • Do something • Health & Wellbeing Board: includes local authority, public health, Healthwatch, head of adult and children's social services reps - Commissioning finance head seeks Input for his/her Recommendation • Transformation Stakeholder Working Group or equiv.: Joint provider / commissioner group - Commissioning finance head seeks Agreement from Trust Board(s) on his/her Recommendation • Commissioning Board (e.g. CCG Board) Decides based on CCG finance head’s Recommendation 2 3 41 What Who HowWhen Sub-Decision: Decide whether to proceed with preferred option(s) and implementation plan Decision component snapshot for sub-decision four DECISION CCG Board CCG finance head CCG commiss. head Trust Board Local Authority Health & Wellbeing Board Regulators Wider GP Community RD A I I IA PP APPROACH DECISION HANDBOOK APPENDIX
- 36. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 36141211_Allocation Decision Han ...LON • “What, who, how and when” - setting the decision up for success • “How” - deeper look at critical elements for each step in the process • Role of finance - key actions, analysis, data and tools for finance Contents APPROACH DECISION HANDBOOK APPENDIX • NHS approach to effective decision making • An holistic definition of value • Data sources and links • Data tools and links • Star modelling tool for value-for-money analysis • AID model for QIPP prioritisation • Stakeholder map and public engagement tool • Programme budgeting marginal analysis • Integrated Risk and Impact Assessment Tool • Decision Trees • Full Business Case template APPROACH DECISION HANDBOOK APPENDIX TIP: Click on any of the text below to skip to that section
- 37. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 37141211_Allocation Decision Han ...LON Role of finance snapshot for sub-decision one Critical Step Actions for Finance Pieces of Analysis Data Data Source Tools / Resources Map resource use by population group CCG Finance: Submit request for analysis to CSU or informatics department. If only able to produce activity levels by patient population, add in cost estimates • Activity and statistical analysis conducted by CSU or informatics team • Costing of activities conducted by finance • Programme activity by population sub-group • Tariff rates by activity • Community, block and other contract information • Secondary Uses Service • Contract data from providers (e.g. SLAM) Refresh / review risk stratification CCG Finance: May overlay cost data on models from informatics specialists / CSU N/A • Outpatient, inpatient, A&E, and GP data • Public Health Data • Hospital Episode Stats • Secondary Uses Service Combined Predictive Risk Model (Kings Fund) Assess baseline costs CCG Finance: Compile current spend data and direct CSU/informatics to model future spend Provider Finance: Identify mismatches between tariff rates and actual cost base • Assess current and projected spend by provider • Review past programme category spend • Assess service line cost • Spend by provider • Spend by programme category • Service line costing info • Existing contracts • SLAM • Dr. Foster • SUS • Internal tracking • Reference costs N/A Compile comparative benchmarking data CCG Finance: Work with commissioning lead to identify opportunities based on relative performance against benchmarks • Identify outliers of (under)performance • Identify explanations and consequences of variation • Programme budgeting • Primary and secondary care • Utilisation data • Evidence from trials in other regions • Dr. Foster PPM Module • QOF • NHS Comparators, Atlas of Variation, Commiss. for Value • SLAM Data N/A Review JSNA and long term priorities of CCG, stakeholders and Health & Wellbeing Board CCG Finance: Assist the commissioning lead in presenting the ideas to check if compatible with long term strategic priorities N/A N/A N/A N/A Role of Finance • Drive integration of financial analysis and outcome analyses (clinical, safety and experience) • Generate a broad range of options for consideration • Translate activity and non-financial data into financial terms; share insights with CCG commissioning director What Who HowWhen • Finance’s responsibility • Non-finance’s responsibility Sub-Decision: Determine areas with greatest opportunity for improved outcomes/cost reduction 2 3 41 APPROACH DECISION HANDBOOK APPENDIX
- 38. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 38141211_Allocation Decision Han ...LON • Finance’s responsibility • Non-finance’s responsibility Role of finance snapshot for sub-decision two Critical Step Actions for Finance Pieces of Analysis Data Data Source Tools / Resources Align stakeholders on criteria for evaluation CCG Finance: Lead process with provider counterparts to formally agree on metrics (incl. activity data) underlying case for change N/A N/A N/A • STAR tool • Looking for Value in Hard Times Conduct service reviews CCG Finance: Establish financial baseline of maintaining current model Provider Finance: Model cost and outcome implications and share with CCG finance • Cost benefit analysis of keeping existing model • Vet cost modelling of alternative models assembled by providers • Medical Appropriateness • Provider level spend • Clinical / trial evidence • QOF data • SLAM data • CSU or provider • Clinical Ref. Group • Diagnostic Steps of a Service Review • Adopt, Improve, Defend tool Appraise relative options CCG Finance: Lead analysis for economic appraisal. Act as a sense check, flag interdependencies and barriers. Review quality impact analysis produced by head of quality Provider Finance: Model cost and outcome implications and communicate internally • Economic appraisal (e.g. financial costs and benefits, ROI, etc.) • Programme budgeting marginal analysis • Quality / Non-financial benefits appraisal (e.g. improved outcomes) • Cost of current service, future baseline cost, procurement and mobilisation costs • Programme category and provider level spend • Patient experience data • Safety data • Evidence from trials • Audit of spend • Reference costs • CSU/ BI activity projections • QOF & SLAM data • HealthWatch • Dr. Foster • Orgs running trials • STAR tool • Looking for Value in Hard Times, The Health Foundation • Program Budgeting Marginal Analysis Toolkit, Right Care Assess wider system impact CCG Finance: Gather and vet the impact on provider resilience Provider Finance: Work with clinical and operations to assess impact and share concerns with commissioner • Provider financial and operational impact • Equity impact assessment • Provider Impact assessment (from providers) • Prevalence and activity data • Provider finance staff • CSU reports • Unify2 database • Integrated Impact Assessment Guide, Milton Keynes CCG Determine if public consultation is required No Finance Role Role of Finance • Own activity and financial data, holding stakeholders accountable for their models and due diligence • Push for rigorous evidence and explicit assumptions on both financial and non-financial benefits • Integrate financial/non-financial analyses into a unified assessment of value What Who HowWhen Sub-Decision: Determine how to improve each opportunity area and the preferred option(s) for improvement 2 3 41 APPROACH DECISION HANDBOOK APPENDIX
- 39. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 39141211_Allocation Decision Han ...LON • Finance’s responsibility • Non-finance’s responsibility Role of finance snapshot for sub-decision three Critical Step Actions for Finance Pieces of Analysis Data Data Source Tools / Resources Identify limiting factors (e.g. equipment, GP shortage, shortage of trainers, etc.) CCG Finance: Lead effort to articulate resources needed to make proposed changes • Forecast of resource requirements and availability under different scenarios Identify potential barriers CCG Finance: CFO drives process as part of senior management team– linking to provider counterparts. Provides financial analysis to those engaging clinicians Provider Finance: Express finance concerns to internal leadership and CCG counterpart • Assess / validate financial risk for providers • Financial impact on providers • Views of Local Authority • Views of clinicians • Views of expert patient groups • Conversations w/ trust counterpart • Conversations w/ local authority counterpart Compile risk appraisal CCG Finance: Develop financial risk appraisal, and gather risk assessments from trusts and inputs from CCG departments (quality, procurement, etc.) • Risk appraisal including clinical, commercial, operational, implementation and timescale risks, scores and mitigants • Likelihood of occurring • Potential Impact • Context • Inputs from chief commissioning officer, head of quality and provider counterparts • Integrated Impact Assessment Guide, Milton Keynes CCG Determine if regulatory approval will be necessary No Role N/A N/A N/A N/A Role of Finance • Own rigorous analysis and insight generation • Identify, quantify and assign probabilities to resource-based limiting factors, barriers and risks • Offer finance view on non-financial limiting factors, barriers and risks What Who HowWhen Sub-Decision: Determine deliverability of preferred option(s) 2 3 41 APPROACH DECISION HANDBOOK APPENDIX
- 40. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 40141211_Allocation Decision Han ...LON • Finance’s responsibility • Non-finance’s responsibility Role of finance snapshot for sub-decision four Critical Step Actions for Finance Pieces of Analysis Data Data Source Tools / Resources Develop full business case CCG Finance: Finalise model and estimates for benefits realisation and impact assessments. Support commissioning director in finalising risk appraisal/ mitigation, and rationalising implementation timescale, milestones and measures • Stress test benefits realisation and cost assumptions • Detailed Impact assessments (equality & system) • Complete risk appraisal and mitigation steps • Implementation timescales, resources, milestones and measures of benefit • A stakeholder map • Communication engagement plan • Outline business case (OBC) • Service Specification and data requirements • Board reporting requirements on implementation • All inputs from previous analyses • Analyses from previous steps • Full Business Case Template, NHS National Innovation Centre • Stakeholder Map & Engagement Tool • Risk Appraisal & Mitigation Tool Role of Finance • Responsible for compiling full business case and presenting recommendation to the board • As board member, push to integrate financial/non-financial analyses into a unified assessment of value What Who HowWhen Sub-Decision: Decide whether to proceed with preferred option(s) and implementation plan 2 3 41 APPROACH DECISION HANDBOOK APPENDIX
- 41. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 41141211_Allocation Decision Han ...LON • “What, who, how and when” - setting the decision up for success • “How” - deeper look at critical elements for each step in the process • Role of finance - key actions, analysis, data and tools for finance Contents APPROACH DECISION HANDBOOK APPENDIX • NHS approach to effective decision making • An holistic definition of value • Data sources and links • Data tools and links • Star modelling tool for value-for-money analysis • AID model for QIPP prioritisation • Stakeholder map and public engagement tool • Programme budgeting marginal analysis • Integrated Risk and Impact Assessment Tool • Decision Trees • Full Business Case template APPROACH DECISION HANDBOOK APPENDIX TIP: Click on any of the text below to skip to that section
- 42. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 42141211_Allocation Decision Han ...LON Data sources for Best Possible Value decisions Data source Value categories Description Useful for Quality and Outcomes Framework (QOF) Safety / Experience / Outcomes GP surgeries metrics on Clinical, Public Health, Public Health, Patient Experience, Quality and Productivity. Benchmarking against peer groups and service reviews. CCG Outcomes Indicator Set (CCG OIS) Safety / Experience/ Outcomes Outcomes at CCG level to help inform priority setting and drive local improvement. NHS Comparators Cost / Outcomes Benchmarking and comparing activity and costs on a local, regional and national level for commissioners and providers Indicative sense of where to look deeper. Data can be old and is not in raw format. NRLS Organisation Patient Safety Incident Reports Safety Data shows patient safety incident statistics for trusts in England and Wales Benchmarking against peer groups for indication of where to look deeper. Commissioning for Value Packs Cost / Experience / Outcomes In-depth comparative data for 13 patient conditions, within the programmes that are most commonly identified as offering the greatest potential improvements. Benchmarking against peer groups for indication of where to look deeper. QualityWatch Indicators Safety / Experience / Outcomes Independent scrutiny and data on access, experience, safety, equity and effectiveness of services across mental, social, primary and secondary care Benchmarking, modelling impact on experience, safety or clinical outcomes for proposed changes. Secondary Uses Service (SUS) Cost / Outcomes Data can be patient identifiable or anonymised or as required for the user's needs. Benchmarking, consumption mapping, and assessing cost base. Doctor Foster Practice Provider Module (PPM) Cost / Outcomes / Safety Analyse and benchmark hospital admissions data across a wide range of outcomes, utilisation, trends and patient records across a region. Benchmarking, consumption mapping, assessing cost base, and forecasting impacts from proposed changes. Health and Social Care Information Centre Population Health Comparative benchmark data, population health, trends over time, health risk factors, and health inequality. Useful for benchmarking, developing a fact base, risk stratification and service planning. Hospital Episode Statistics Provider Cost / Activity HES is a data warehouse containing details of all admissions, outpatient appointments and A&E attendances at NHS hospitals Risk stratification Patient Reported Outcome Measures Tool (PROMT) Cost / Outcomes / Population Health Data collected for 4 procedures: hip and knee replacements, groin hernia and varicose veins. The tool enables commissioners to examine the relationship between a range of local factors Risk stratification. Benchmarking against peer groups for indicative sense of where you could look deeper. Service Level Agreement Monitoring (SLAM) Cost Monthly dataset provided by CSUs to CCGs including detailed breakdown of services performed by providers. Useful for contract management, and assessing current cost base. APPROACH DECISION HANDBOOK APPENDIX
- 43. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 43141211_Allocation Decision Han ...LON Data tools for Best Possible Value decisions Tool Description Useful for Full Business Case Template Detailed outline and suggested analysis for a Full Business Case from the NHS National Innovation Centre. Public Sector Business Cases Using the 5 Case Model Toolkit Template and guidance, including content outlines, for developing outline and full business cases for specific decisions. Outline Business Case / Full Business Case Health Investment Network programme Budgeting Benchmark Tool Enables NHS organisations to identify: how they spend their allocation over the 23 diseases and their respective subcategories; how, and by how much, their expenditure distribution pattern compares with other commissioners nationally, locally or with similar characteristics; and how their expenditure distribution has changed over time. programme budgeting marginal analysis Combined Predictive Risk Model A model that used inpatient, outpatient, A&E and GP data to stratify populations according to their risk of admission. In order to run this model, a software front-end needed to be built locally. Intellectual property is owned by the Department of Health. Risk Stratification Adopt Improve Defend (AID) A Right Care process that supports both the need to generate good ideas for reform in the priority areas needing focus and the need to engage the wider health community in these reforms. Evaluating and prioritising service model options. Socio-Technical Allocation of Resources (STAR) London School of Economics (LSE), the Health Foundation has developed the Star approach that combines value for money analysis with stakeholder engagement, where an Excel-based tool is used alongside a facilitated stakeholder workshop. Spend and Outcomes Tool (SPOT) Graphically illustrates where you stand, compared to similar CCG populations, on the health outcomes you are achieving for your health spend. Indicative sense of where you could look deeper. Sense check on proposals under consideration. Inpatient Variation Expenditure Tool (IVET) Benchmark and compare their inpatient spending (adjusted for age, sex and needs) on diseases and interventions with other PCTs to improve future investment decisions. Calculate potential savings by reducing admissions across major disease groups and for interventions with the highest spend. Public Engagement Toolkit A guide for anyone who needs to engage with the public about health care commissioning. Designed for commissioners. Practical advice on how to go about public engagement Programme Budgeting Benchmarking Tool Framework for estimating / benchmarking expenditure across healthcare conditions, also known as ‘programmes categories’, across the whole care pathway. Benchmarking against peer groups for indication of where to look deeper. Data can be slightly outdated and is not in raw format. APPROACH DECISION HANDBOOK APPENDIX
- 44. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 44141211_Allocation Decision Han ...LON STAR - a modelling tool and approach for value-for-money analysis and stakeholder engagement MODEL OVERVIEW DOWNLOADABLE RESOURCES Source: The Health Foundation, Star Online Demonstration. Star (Socio-Technical Allocation of Resources) is an innovative approach that supports commissioners’ budget prioritisation processes. By combining a technical value-for-money analysis with extensive stakeholder engagement and discussion, Star enables commissioners to involve the wider community in the evaluation of a range of current or potential interventions. • Star comprises a technical tool and a workshop-led process • Online video training, demonstrations and downloadable resources are available Case Study Excel modelling tool Learning report and examples User guide APPROACH DECISION HANDBOOK APPENDIX
- 45. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 45141211_Allocation Decision Han ...LON Adopt, Improve, Defend - an AID for QIPP by Right Care MODEL OVERVIEW DOWNLOADABLE TOOLKIT Source: Right Care, ‘Adopt, Improve or Defend’ – An AID for QIPP. September, 2013 A systematic approach to achieve challenging QIPP targets by identifying and addressing variations in local healthcare. The AID methodology provides commissioners with a structured process to assess, challenge and improve promising QIPP ideas: - Adopt – implement the idea as presented - Improve – adapt the idea - Defend – reject the idea and retain the current position The intention is that the process is intended to support high-value commissioning on an on- going basis. APPROACH DECISION HANDBOOK APPENDIX
- 46. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 46141211_Allocation Decision Han ...LON Satisfy • CQC • MPs • Health and wellbeing board • Overview and scrutiny • Local Authority • NHS England • Competition and Markets Authority Manage • Provider boards and governors • Commissioning boards and governance • Partners • Monitor Monitor • Media Inform • Patients and public • Provider workforce Power Influence Low High High Low Note: More detailed guidance and recommendations on stakeholder engagement, tracking, and management can be found here at NHS Networks Source: NHS Central Lancashire, Public Engagement A toolkit for health commissioners and partner organisations Institute for Innovation and Improvement, Stakeholder Analysis STAKEHOLDER MAP DOWNLOADABLE TOOLKIT Stakeholder map and engagement toolkit APPROACH DECISION HANDBOOK APPENDIX
- 47. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 47141211_Allocation Decision Han ...LON • Compile programme budget spend by category across age groups in so far as local data and estimates permit. • Identify the top 10 health programmes in each of the major providers and look at the differences. • Discuss the differences and identify the networks and pathways these patterns reveal. • Compile programme budget category spend by provider across all providers • Compiling this table will help identify relative size of each provider’s contribution and how programme expenditure relates to provider expenditure • Compile the follow data across programme budget category for the most recent year: - Spend per 100,000 weighted population - Average spend per 100,000 population among peer group - Average spend per 100,000 population in England Programme Budgeting Marginal Analysis Source: Right Care, The Third Annual Population Review: Commissioning for Health Improvement INPUT PROCESS OVERVIEW DOWNLOADABLE TOOLKIT Step 2 Step 3 Step 4 Step 1 APPROACH DECISION HANDBOOK APPENDIX
- 48. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 48141211_Allocation Decision Han ...LON Integrated Risk and Impact Assessment Source: Milton Keynes CCG, Quality and Equality Integrated Impact Assessment Policy Identify Identify risks associated with safety, patient experience, clinical, operations, financial, reputation, etc. Score An overall risk score for each element based on the level of impact and likelihood of occurrence Investigate Scores above a certain threshold (e.g. above 8) should be investigated further Mitigate Mitigation plans should be developed for high risk/impact items and integrated into the Full Business Case RISK APPRAISAL PROCESS DOWNLOADABLE TOOLKIT Likelihood Description Risk Score Very High Will undoubtedly occur, possibly frequently 5 High Will probably occur but not a persistent issue 4 Medium May occur occasionally 3 Low Do not expect it to happen but it is possible 2 Very Low This is unlikely to ever happen 1 Impact Probability Very Low (1) Low (2) Medium (3) High (4) Very High (5) Very Low (1) 1 2 3 4 5 Low (2) 2 4 6 8 10 Medium (3) 3 6 9 12 15 High (4) 4 8 12 16 20 Very High (5) 5 10 15 20 25 Key Low Risk (1-3) Moderate Risk (4-9) Significant Risk (10-14) High Risk (15-25) SAMPLE SCORING TEMPLATE APPROACH DECISION HANDBOOK APPENDIX
- 49. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 49141211_Allocation Decision Han ...LON 1. Implementation cost is less than £x 2. Changes demonstrate value for money 3. Contributes to CCG priority areas 4. Has no adverse impact on health inequalities 5. Meets at least one of the triple aim components (better health, best care (clinical & patient), value for money) 6. Net savings in the system 7. Timeline to payoff/desired benefits Source: Matthew Cripps. Right Care, Healthcare Reform Business Process Guide. 2013. KEY CRITERIA Example QIPP prioritisation decision tree (1/2) APPROACH DECISION HANDBOOK APPENDIX
- 50. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 50141211_Allocation Decision Han ...LON Example QIPP viability decision tree (2/2) Proposal Is there evidence that proposal could improve health outcomes for the population of Doncaster? Is there evidence that this proposal may deliver better value for money (i.e. achieving the same health outcomes for less money) Do not proceed Is this proposal achievable within realistic timescales; i.e. are there constraints for example contractual delays, financial constraints, HR issues, training issues that make progress inappropriate Can constraints be managed within resources? Proceed to prioritisation no no yes yes Step 1: Initial viability assessment v 1.2 noDo not proceed no Source: Matthew Cripps. Right Care Briefing for HFMA on Option Prioritisation and Impact Assessment. May, 2013. APPROACH DECISION HANDBOOK APPENDIX
- 51. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 51141211_Allocation Decision Han ...LON Full Business Case template Source: NHS National Innovation Centre, Full Business Case Template. 2012. BUSINESS CASE TEMPLATE DOWNLOADABLE TOOLKIT This Business Case template provides an outline structure and notes to describe the content required for each section in a Business Case document. There are many formats for a business case, but the information you include should be the background of the project, the expected business benefits, the options considered (with reasons for rejecting or carrying forward each option), the expected costs of the project, a gap analysis and the expected risks. You should also consider the other options, including the option of doing nothing, with the costs and risks of inactivity. This information will help you to identify a clear justification for the project. APPROACH DECISION HANDBOOK APPENDIX
- 52. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 52141211_Allocation Decision Han ...LON Example deliverability dashboard for communicating to stakeholders Rating Comments / Context / MitigantsGood/great So-so Poor • xxxxx • xxxxx • xxxxx • xxxxx • xxxxx • xxxxx • xxxxx • Xxxxx • xxxxx Source: Bain interviews with NHS officials, November 2014 Time to Implement Availability of Resources Required Provider Support Clinician Support Public/Political Support Other… APPROACH DECISION HANDBOOK APPENDIX
- 53. This information isconfidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 53141211_Allocation Decision Han ...LON Key diagnostic steps in conducting a Service Review Source: NHS Right Care Case Book. Identifying “Value Opportunities” in West Cheshire: Service Reviews and Business Process Engineering. November 2013 Current Service Future Service Fit for purpose Efficiency and market options Supply and capacity options No/low benefit Maintain Redesign, contract, procure Contract, procure, divest Divest Step 1: Define Step 2: Define Step 3: Categorise Step 4: Recommend APPROACH DECISION HANDBOOK APPENDIX