Outcome capitated models explained

The need for a new approach

An estimated 20% of healthcare spend is wasted on overuse, misuse or underuse of care. Even in areas with low relative spend, there are still inefficiencies.

Traditional healthcare commissioning in the NHS has tended to focus on processes: numbers of appointments, attendances, operations and procedures. But, with static funding levels, growing demand and unexplained variation in clinical care between providers, we need a new mechanism.

COBICs are a refreshing mechanism that instead rewards both value for money and outcomes that are important clinically and to patients.

Evidence from around the world suggests we need to: 

  • Reduce fragmentation of the delivery system
  • Improve use of data and evidence
  • Engage clinicians s Involve the public and patients in design, delivery and evaluation
  • Align individual and organisational incentives with the goals of the system

The COBIC solution

COBIC stands for Capitated and Outcome-Based Incentivised Contract. The COBIC approach to commissioning allows commissioners to get the best out of their responsibilities handed to them from the NHS reforms, and ensures they best meet their obligations as commissioners. COBICs are a vehicle to achieve this as they:

  • concentrate on outcomes
  • better reflect public and user values
  • properly engage clinicians in service design

A radical new way of working

Each COBIC covers all care for a given group of people. For example, those with or at risk of mental health problems, or those with musculoskeletal disorders.

A COBIC’s budget is based on an understanding of the needs of that population and includes significant financial rewards for achieving specified outcome measures. To deliver those outcomes and make the efficiency savings necessary to stay within the allocated budget, providers must collaborate and problem solve.

COBICs are not block budgets. A COBIC’s finances will be based on a weighted per person cost and, through the outcome-based incentives, will reward groups of providers that together deliver high quality care.

COBIC incentives are more than CQUINs: financially, a COBIC outcome measure will be worth a greater percentage of the total contract value than a CQUIN, and its achievement will require providers to work together rather than in isolation.

COBIC outcomes categories

Every COBIC will:

  • cover a definable ‘cost-able’ pathway have significant potential of either savings or quality improvement within existing budget include measurable outcomes that: 
    • can be improved
    • are relative to local need
    • improve health inequalities
    • are appealing to the market, with scope for encouraging innovation in the provision of care
    • build on existing evidence

COBIC contracting is a way that commissioners can generate the right sort of change – and in the process, improve value for the tax-payer and outcomes for service users. Contracting for an integrated care pathway which leads to health care outcomes is a big step and a big change from existing contracts. It is therefore a radical change but goes with the grain of what clinicians and patient groups want to see

Benefits of the COBIC approach …

… to patients

  • Improved outcomes, such as more time living independently at home, reduced readmissions, improved access to care
  • Improved experience of care as care is less fragmented & better coordinated
  • Patients are better informed about their care and receive more choice

… to commissioners

  • Binding contract with real penalties and rewards tied to defined performance targets
  • Improved value for taxpayers money, defined around the patient
  • Streamline the bureaucracy and administration associated with managing multiple contracts

… to providers

  • Improved financial stability
  • Providers able to align patient pathways and care processes with outcomes
  • Clearer vision from commissioners about what reimbursement will be based on over a period of several years

Original article here

  • 25th February 2016