Commissioning

Why is it important?

Commissioning, inc. Population Health Management, is aimed at improving the health of an entire population. It is about improving the physical and mental health outcomes and wellbeing of people, whilst reducing health inequalities within and across a defined population. It improves population health by data driven planning and delivery of care to achieve maximum impact. It includes segmentation, stratification and impact modelling to identify local ‘at risk’ cohorts – and, in turn, designing and targeting interventions to prevent ill-health and to improve care and support for people with ongoing health conditions and reducing unwarranted variations in outcomes.

Commissioning is the continual process of planning, agreeing and monitoring services. Commissioning is not one action but many, ranging from the health-needs assessment for a population, through the clinically based design of patient pathways, to service specification and contract negotiation or procurement, with continuous quality assessment.

To conduct commissioning, including population health management, national datasets are linked with GP data via the pseudonymised NHS Number to build a linked dataset to understand the needs of the population, to inform the commissioning of services and interventions.

ICBs use the commissioning process to plan, purchase and monitor health and care services for their population. ICB Commissioning comprises a range of activities, as described below:

• Population health management - detailed further here
• Data Quality and Validation - allowing data quality checks on the submitted data.
• Thoroughly investigating the needs of the population, to ensure the right services are available for individuals when and where they need them.
• Understanding cohorts of residents who are at risk of becoming users of some of the more expensive services, to better understand and manage those needs.
• Monitoring population health and care interactions to understand where people may slip through the net, or where the provision of care may be being duplicated.
• Modelling activity across all data sets to understand how services interact with each other, and to understand how changes in one service may affect flows through another.
• Service redesign
• Health Needs Assessment - identification of underlying disease prevalence within the local population
• Patient stratification and predictive modelling - to highlight cohorts of patients at risk of requiring hospital admission and other avoidable factors such as risk of falls, computed using algorithms executed against linked de-identified data, and identification of future service delivery models.
• Demand Management - to improve the care service for patients by predicting the impact on certain care pathways and support the secondary care system in ensuring enough capacity to manage the demand.
• Support measuring the health, mortality or care needs of the total local population.
• Provide intelligence about the safety and effectiveness of medicines.
• Allow analysis of patient pathways across healthcare and social care.

The ICBs commissioning purposes require the use of large scale, whole ICB population, use of national datasets combined with local flows and Primary Care data.

How will it be done?

The commissioning process will be implemented through a systematic approach that leverages data-driven methodologies to inform service planning and delivery. Initially, the Integrated Care Board (ICB) will conduct a comprehensive health-needs assessment to identify the specific requirements of the local population. This assessment will utilise national datasets, which will be combined with GP data linked via pseudonymised NHS Numbers, creating a robust linked dataset that provides insight into population health trends and needs.

Population Health Management (PHM), detailed further here, will be central to this process. Detailed data analysis will allow the ICB to segment the population into distinct cohorts, particularly those at risk of poor health outcomes or requiring more intensive health services. This segmentation will inform targeted interventions, enabling healthcare providers to focus resources on the most vulnerable groups and thereby reduce health inequalities.

The ICB will implement rigorous data quality and validation checks to ensure the integrity of the data being used. This will involve thorough scrutiny of the submitted data to confirm its accuracy and reliability. By ensuring high-quality data, the ICB can better understand patient flows, enabling effective modelling of healthcare interactions and identifying areas for service redesign.

The ICB will use the available data to produce various reports to support its commissioning activities, such as aggregate reports, dashboards for project and programme levels, and detailed analyses of quality metrics across acute, community, and mental health services.

These commissioning efforts aim to improve resource allocation, enhance patient care, and reduce health inequalities by ensuring that the right services are available for individuals when and where they need them. Ultimately, the use of commissioning data will lead to better patient experiences and health outcomes through effective planning and tailored interventions.

What will be the outcomes?

The main objectives are:

• Improving the physical, mental health outcomes and wellbeing of people, whilst reducing health inequalities within and across the region / locality.
• Reducing re-occurrence of ill-health, including addressing wider determinants of health, and collaborating with communities and partner agencies.
• Addressing the wider determinants of health to early intervention, primary, secondary and tertiary disease prevention.
• Producing trajectories, changes in variation over a period of time, including the impact on the economy at region and locality level

The use of commissioning data enables the improved planning by better understanding the patient flows through the healthcare system. Allowing Commissioners to design appropriate pathways to improve patient flow and identify priorities / plans to address:

• Commissioner reporting on providers, finances, readmission analysis
• Production of aggregate reports for ICB Business Intelligence.
• Production of project / programme level dashboards.
• Monitoring of acute / community / mental health quality matrix.
• Clinical coding reviews / audits.
• Budget reporting down to individual GP Practice level.
• GP Practice level dashboard reports.
• Comparators of ICB performance with similar ICBs as set out by a specific range of care quality and performance measures detailed activity and cost reports.
• Data Quality and Validation measures allowing data quality checks on the submitted data.
• Contract Management and Modelling.
• Manage demand, by understanding the quantity of assessments required ICBs are able to improve the care service for patients by predicting the impact on certain care pathways and ensure the secondary care system has enough capacity to manage the demand.
• Identify low priority procedures which could be directed to community-based alternatives and as such commission these services and deflect referrals for low priority procedures resulting in a reduction in hospital referrals.
• Compare providers (trusts) mortality outcomes to the national baseline.
• Identify medication prescribing trends and their effectiveness.
• Linking prescribing habits to entry points into the health and social care system.
• Identify, quantify and understand cohorts of high numbers of different medications (polypharmacy).
• Feedback to NHS service providers on data quality at an aggregate and individual record level only on data initially provided by the service providers. Reduce emergency readmissions, especially avoidable emergency admissions by improving quality of services. This is achieved through the mapping of frequent users of emergency services and supporting early intervention.
• Improved access to services by identifying which may be in demand but have limited accessibility. Then from this identify areas where improvement is required.
• Supports the Commissioner to meet its requirement to reduce premature mortality in line with the ICB Outcome Framework by allowing for more targeted intervention in Primary Care
• Better understanding of local population characteristics through analysis of their health and healthcare outcomes

All of the above lead to improved patient experience and health outcomes through more effective commissioning of services.