The final step in designing and costing the new model of care is to understand the impact that the model will have on both outcomes and financial sustainability.The final step in designing and costing the new model of care is to understand the impact that the model will have on both outcomes and financial sustainability.
When assessing the costs and benefits of new models of care, the most important impact is on people. Providers and commissioners measure their impact on people by measuring outcomes. How to assess the impact on outcomes is discussed in Chapter 5: What are the outcomes to be delivered? An example of how a new model of care might work, and how it could impact an individual service user can be found in the Conclusion of this chapter.
It has been well established in other systems that new models of integrated care can produce significant cost savings. The exhibit below shows some examples of this.
There are three steps that providers will need to go through to think about how to estimate the potential impact of their new models of care. These are outlined below:
- Understand where the savings could come from
- Establish a methodology for estimating these savings
- Calculate the possible savings for the particular group
Step 1. Understand where the savings could come from
Cost savings can come from anywhere across the system. This includes acute, primary, social, community and mental-health care. For example, in acute care, savings can come from non-elective admissions, elective admissions, outpatient appointments or A&E attendances. The first step for providers is to identify where in the system their savings could potentially come from.
The most likely place for savings to come from integrated care is in non-elective hospital admissions and other acute services. One of the major ideas of integrating care is to shift care from expensive settings, like the emergency room, to cheaper settings, like the home or the community. By adding more preventative support, many integrated care interventions aim to reduce the burden on the acute sector.
Step 2. Establish a methodology for estimating these savings
Once providers have given some thought to where they think the savings could come from, the next step is to actually estimate these potential savings so that they can be compared with the costs calculated in the previous section. There are many methodologies that can be used to estimate savings – robust analysis is likely to draw on more than one. A few of them are shown in the exhibit below.
Step 3. Calculate the possible savings for the particular group
After establishing a methodology and deciding where the savings will likely come from, the last step is to calculate the actual impact. The calculation for this at a high level is shown below.
Total cost attributable to relevant area of saving for the group
*
Potential percentage savings estimated with chosen methodology
=
Potential estimated savings
The final model of integrated care in North West London will be centred around individuals, with a focus on involving carers, families and communities in care and wrapping an integrated health and care system around individuals as holistically as possible. For a single-service user with complex needs, this means that care will change considerably. The story below shows how care might change for a single person.
John is 54 and lives with his elderly parents. John was diagnosed with schizophrenia when he was 22. He also smokes and has COPD. He has been referred several times to the Mental Health Assessment Team in Ealing, but due to lack of communication, John has never been seen by them. John’s parents, Emily and Thomas, often feel overwhelmed by caring for John.
As a result of integrated care programmes being adopted for people with serious and enduring mental illness, John’s care changes. Instead of getting sporadic referrals to services from his GP, John is now cared for by a dedicated, co-located multi-disciplinary team headed by his new care coordinator, Caroline. Caroline sits with John, his parents and his GP to create a care plan, which records his personal goals of being able to garden more often and going to the shops once a week. It also lays out that John will see someone from the MDT at least twice a week, and that Caroline will call him twice a week to check in on how he is doing. John also goes in to the clinic where his MDT is co-located once every two months to see a specialist about his COPD.
Caroline also provides John and his parents with a collection of educational materials about his condition, which she explains to them during a longer meeting. John is set up with a befriending service, through which he finds a volunteer to help him garden on sunny days. Finally Caroline sets John with a training programme that is run by the MDT to improve mood in people with serious and enduring mental illness. Through this new model of care, John is personally empowered to care for himself; he has a dedicated MDT and care coordinator and a personal care plan. He also has a host of other care initiatives that support his care.
After two years in the programme, John has been hospitalised only twice, compared to four times in the two years prior to the programme being implemented. He reports he is happier with his care, and his parents feel that better care is being provided for their son. The whole family has a close relationship with Caroline and the rest of the MDT, and they feel they have good continuity of care.
To implement Whole Systems approach, you will need to plan for and complete the following:
- Convene a relevant group of service users, carers, care professionals and commissioners to co-design the new model of care, and hold the meetings suggested in the first section during the design phase
- Perform a detailed analysis of your baseline costs, activity, services provided and workforce, using a linked individual-level data set. For more information on this, see Chapter 4: What population groups do we want to include?
- Set your wide financial and outcomes goals together with the group
- Design the new model of care, which includes: what interventions, what specific services, who will provide them, where and how often
- Calculate the entire team that will be needed to achieve this new model of care and model the costs for employing this team to care for the given population
- Calculate the overall impact that the new model will have on people and on financial sustainability