In our experience supporting the development of new models of care, Gareth Hartley, Attain Director talks about the importance of an outcome-focused approach. The outcomes to be achieved from new models of care are an important feature in determining their “function” before moving to develop their “form”, and enabling providers to be held to account whilst giving them the flexibility to introduce new and innovative ways of delivering services. This brief summary addresses some of the key areas related to this topic, with specific reference to care outcomes as opposed to outcomes across other domains (e.g. financial).
The inherent requirement of all health and care systems and models is to improve outcomes for people. Outcomes represent the end result of care and can be reported from individual to population level, however should always indicate the health status of individuals and ideally reflect the care model in its entirety. Outcomes serve to validate the quality and effectiveness of care and can be understood through their differentiation from care structures (describing the care environment such as staffing ratios and equipment access) and care processes (such as health screening and treatment interventions). Whilst care structures and processes are clearly important in affecting outcomes, there is no better alternative to measuring outcomes themselves. Equally, when analysed in relation to costs, outcomes also tell us about the value of care in economic terms, an important consideration for commissioners and providers alike given the financial pressures currently faced across the care system.
Measuring, communicating and monitoring outcomes serve a number of purposes, such as:
- Communicating the objectives of new care models – outcomes selected should tell the story of why the new care model is being developed and delivered
- Assessing the impact of new care models whilst also identifying areas for outcome improvement – for example, by assessing those interventions that are most likely to improve quality of life in individuals, or improve survival rate and rehabilitation outcomes following major medical events. A range of evidence-based person-reported outcome measures exist for use that measure health status across a range of dimensions, for example mobility, self-care and wellbeing, that can be selected as appropriate for the care model.
- Driving and incentivising behaviour change – outcomes can be used to influence behaviour change and promote innovation whilst removing non-value adding elements of delivery
- Challenging model approaches – in new models of care, a focus on outcomes may mean moving away from traditional care models to new or innovative approaches which affect the wider determinants of health, for example those which may be social or environmental in nature. An outcomes based approach to commissioning therefore affords providers the flexibility to determine which model is most likely to best achieve the desired outcome for the population in a cost effective fashion.
Key considerations for outcome measurement in new care models
Lessons from the design, development and implementation of new care models can help ensure outcome measurement is purposeful and effective. The following considerations may help those commissioning and providing new models of care:
- Focus on value and what matters most to people
- Develop a transparent outcome framework; select and measure a small number of balanced, high impact outcomes proportional to the care model scope and be clear about who is accountable for outcome delivery
- When selecting outcomes think about their purpose and the measurement process such as the outcome formula, frequency and source of data; check outcomes are focused, relevant, valid, reliable, accessible and timely
- Don’t re-invent the wheel – use the evidence to guide outcome selection and utilise available existing frameworks such as the NHS Outcomes Framework or Adult Social Care Outcomes Framework
- Understand cause and effect of decisions in relation to the care model on outcomes in both the short and long-term
- Be aware that it may not be feasible to move from traditional input driven specifications and KPIs to an outcomes based approach in a single contracting round. It will take time for providers to develop the process required measure the desired outcomes, and baseline their current levels of performance, before they can be held to account for delivering them
- Develop an appropriate way of incentivising the achievement of specified outcomes through contract payment mechanisms
Find out more about our work developing new models of care or to speak to us about how we have implemented outcomes based approaches and measured specific outcomes in new models of care contact Gareth Hartley.