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Helping Commissioners achieve outcomes-based commissioning

Ben Chance has been working closely with Councils on their outcomes-based commissioning journey for the last 5 years. Here he shares some of the background and latest thinking.  

“Whilst the benefits of outcomes-based commissioning are well-accepted, finding meaningful and workable ways of implementing them in practice is still challenging.

Outcomes-based commissioning offers the benefit of having a clear purpose for every visit and a focus on achieving greater independence, but it involves a major shift in the way people in the care sector work.

Professor John Bolton, independent consultant in social care and visiting Professor at the Institute of Public Care at Oxford Brookes University, has been exploring outcomes-based commissioning since its inception. In his 2015 discussion paper, he observed that Councils moving to outcomes-based commissioning have found it tough to make the transition. However, he notes that “there is a compelling logic that if social care could be delivered in a more effective way, which rewarded Providers who delivered improved outcomes, then everyone would benefit.”

Moving to outcomes-based commissioning for reablement services is relatively easy. The biggest challenge is adopting outcomes-based commissioning across all Adult Social Care delivered by external Providers. In many situations improvement is not an option, but realistic outcomes still need to be set so that Providers can be targeted and paid accordingly.

Collecting data for contract management is key and many outcomes innovators have recognised the value of combining outcomes data with real-time service delivery data.   

Evolving ‘time and task’ monitoring

The current ‘time and task’ model is often criticised, with many feeling it encourages short visits and increases dependence on care services. When considering how to move away from ‘time and task’, it’s important that the ‘time’ element is not completely lost. Time is crucial for planning care visits and reducing the risk of missed visits.

When homecare users are asked what is important to them, they want Care Workers to arrive on time and they want continuity of care.  Both of these can be monitored in real-time at the point of care delivery, whilst also collecting information on progress towards outcomes.  

Professor Bolton recognises that some Councils have concerns over outcomes-based commissioning as they want to ensure that every hour delivered is accounted for. He suggests that Councils can still monitor the hours actually spent through electronic monitoring as part of contract monitoring.   

Payment-by-Results

Payment-by-results is one of the most challenging elements of outcomes-based commissioning and finding a straight-forward model that works for all parties is difficult. From my experience, Councils seem to be favouring an approach that offers a percentage core payment for services provided (say 80%), with the remainder available as a reward element that could be gained by the Provider if they achieve agreed outcomes. Interestingly, research by the Local Government Information Unit indicated that full payment-by-results isn’t necessary or even desirable. That seems a sensible conclusion considering how complicated it would be to set up and manage full payment-by-results. And let’s not forget that whatever system is put in place needs to reflect the fact that many Providers pay their Care Workers based on time.

Technology to record and share progress towards outcomes

Our innovative Outcomes Assessment Platform is helping Councils move towards outcome-based commissioning.  The powerful combination of time / attendance data and progress towards outcomes ensures the right care is delivered at the right time. The model is based on a generic framework, so it can accommodate all common forms of assessment as well as bespoke ones.

The Outcomes Assessment Platform delivers comprehensive management information to evidence Service User improvement / deterioration. It also gives valuable insight into service delivery, the impact of interventions and resource productivity which can inform commissioning decisions. The solution supports payment-on-results by using a blend of quantitative and quality / outcomes measures.

With the move towards health and social care integration, the Outcomes Assessment Platform is ideal for sharing real-time information between different agencies.

I’ve had the opportunity to work alongside transformation teams in services across the country to develop workable models using our Outcomes Assessment Platform. I’ll shortly be organising another of our Outcomes Think Tank sessions where Councils have the opportunity to share information on what they are doing and get input and feedback from one another. If you’d like to be involved in one of these sessions please get in touch.” 

Ben Chance can be contacted on 0121 308 3010 or ben.chance@cm2000.co.uk 


Written by:

Ben Chance, CM2000 Market Manager
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