Reduce costs: understand your population, risk stratify patients

December 10th 2015 ...in category Commissioning Excellence

In my previous blogs about our report on MS admissions, I highlighted the vast and costly scale of emergency admissions in MS, and that the most common reasons for these are largely avoidable ones.

This points towards a large scope to make savings while also reducing admissions for acute Ambulatory Care Sensitive Conditions (ACSCs) in these patients.

The first major step towards achieving this goal is to understand your population. This means using data to get a better understanding of local needs and how services are performing and meeting those needs. One clinician I spoke to, Karen Vernon, MS Nurse Consultant in Salford, highlighted how she is now using data to support their service redesign in MS; she said it has taken a while to get to grips with things but she is now “data hungry”!

"Understanding your local population can start with the basics of mapping out how many people have MS in your area (or simply how many people you would expect) and so anticipating the services you will need to provide."

Data is essential because often we find that CCGs are commissioning services on a historical basis rather than using the vital intelligence that data can provide. Understanding your local population can start with the basics of mapping out how many people have MS in your area (or simply how many people you would expect) and so anticipating the services you will need to provide. This way services can be commissioned carefully.

Our report highlighted how important intelligence-led commissioning is, because there is a wide variation between the geographical regions in England, showing large differences in admission rates and costs for the emergency care of people with MS (between Clinical Commissioning Groups (CCGs) and also between CCGs within the same Strategic Clinical Network). For example, we found that the number of admissions per (estimated) 1,000 per people with MS in 2013/14 shows a six-fold variation between the lowest and highest CCG.

Part of this will be down to local variation in the prevalence of MS. However, our analysis is somewhat limited because it is hard to assess the impact of this without an accurate record of MS prevalence in England.

Nonetheless, the significant variation remaining suggests that there is scope in many CCGs to address non-elective emergency care in MS. Among the CCGs with the highest costs, non-elective admission costs may be dramatically skewed by a small number patients incurring high-cost admissions. These CCGs would do well to manage these costs better by risk stratifying their patients and managing patients at high risk of emergency admission more proactively. However, all CCGs would no doubt benefit from this approach.

Identifying high-risk patients and ensuring they are monitored and have more supportive, anticipatory care in place, is just one aspect of good practice in MS. It not only goes a long way towards putting well-planned services in place for people with MS which improves wellbeing, but it also reduces unnecessary admissions and their associated costs and helps to reach targets to reduce ACSCs too.

In my next blog I will look at other important aspects of a ‘good service’ for people with MS – integration and the crucial role of the MS specialist nurse.

Read the full report on MS here.

About the Author


Sue Thomas

Sue Thomas

Chief Executive for Commissioning Excellence

sue.thomas@nhis.com
View more posts by Sue Thomas

December 10th 2015
...in category Commissioning Excellence

Commissioning Excellence

As one of NHS England’s recognised niche specialist commissioning support providers, we offer a full range services to assist you in improving patient outcomes. Our experience covers all long term conditions, with a particular specialism in the field of neurology.

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