Savings Realised through the Improved Care and Efficiency Committee (ICEC)
UnitedHealth UK created the Improved Care and Efficiency Committee (ICEC). The purpose of the ICEC is to find opportunities for clinical savings and has helped the CTP to realise over £1 million in savings through activities such as: Audit/coding review for surgical thresholds; Reducing A&E visits and admissions; Managing unscheduled acute care and discharge planning; Enhancing complex case management; and Directing care to less-intensive venues.
Population Risk Stratification using Health Numerics Risc (HNR)
HNR is a predictive modelling tool that provides information to the CTP on patients across the population with the highest risk of a hospital attendance and/or admission (by all GP practices). The tool analyses the number of long-term conditions in the CTP, previous Accident and Emergency (A&E) attendance, unplanned admissions, as well as other statistically-significant predictors of risk. Lists of high risk patients are shared with the community nurse working within A&E, the Discharge Liaison team, and community matrons to quickly identify individuals that require case management. HNR has enabled the CTP to advance a complex case management initiative that is fundamental to integrated care.
Case Management and Integrated Care
UnitedHealth UK led the development of integrated assessment tools by gathering representatives from health and social care teams—including community matrons, district nurses, therapists, and social workers. These teams advance an integrated care model for patients at-risk for emergency attendance and/or admission to the acute sector by identifying at-risk individuals known to both health and social care teams. Pilots across three practices were established to determine target patient populations. Individual patients were then scored by their needs to determine a level of risk and appropriate intervention. Roll out across the entire PCT has now begun.
Electronic Record to Track Outcomes
In order to track performance during the Case Management pilots, during CTP-wide roll-out and also to be ready for the launch of the rapid response team, UnitedHealth UK have developed an ‘Activity, Intervention and Outcomes’ database to be used by the integrated health and social care multidisciplinary team, including Complex Case Managers, Rapid Response teams, and A&E community nurses. The goal of the database is to provide an interim solution until the CTP complete development of a single record system for performance outcomes in 2010/2011. The database shows that between January and March of 2010, 65 individuals were seen by a ‘rapid responder’ avoiding 17 hospital and 14 immediate tier bed admissions, creating a saving in excess of £65,000. More than 500 face-to-face direct care calls were made by the team, avoiding 215 hospital bed days. Complex Case Management performance tracking is also now underway.
Comprehensive Gap Analysis and Robust Health Economics Strategy
North East Lincolnshire Care Trust Plus commissioned United Health UK to undertake a comprehensive gap analysis between existing and required WCC competency levels. Following the analysis, UnitedHealth UK created an action plan to fill the gaps and developed a toolkit to embed the WCC competencies and reporting processes in the commissioning cycle. The toolkit takes users through the required steps for World Class Commissioning within the commissioning cycle—and highlights best practice tools and resources. UnitedHealth UK have also helped to build a robust Health Economics Development Strategy. As a result, the CTP is now working with tools including UnitedHealth UK’s HNR and predictive modelling—and will soon pilot use of Quality Adjusted Life Years (QALYs)—to further support its strategic commissioning with actionable data.
Community Engagement for CTP Priority Setting
UnitedHealth UK have worked alongside Membership Engagement Services (MES) and the CTP to implement the first elected community membership model in the NHS. The model makes a special effort to include ‘hard-to-reach’ and vulnerable groups. To implement the model, UnitedHealth UK supported the CTP in the election of 18 public representatives to the ‘Commissioning Group Boards’. The representatives are elected from a community membership group of 2,200. Seven of the elected representatives sit on Commissioning Group boards where they will have a majority vote in the commissioning decisions of the CTP. Any member of the community is eligible to join the larger community-membership group.
Client Testimonial - Julie Warren, Director of Strategy & Partnerships
"United Health UK has supported North East Lincolnshire Care Trust Plus with World Class Commissioning. This ranged from advice and support about the different elements to directly producing some toolkits and strategies. The experience and challenge that they brought to the process enabled the CTP to rise in the HSJ league table to 5th nationally and the greatest improvement to any other organisation assessed."