How smarter sharing can boost population health

4th May 2022

How can we best support the NHS to improve health outcomes of the populations they serve, asks Civica’s Tracey Cotterill

How can we best support Integrated Care Systems (ICS) to improve health outcomes of the populations they serve; both through better healthcare delivery and recognising the external factors that must be managed to drive success?

I recently joined an HFMA roundtable to discuss how we move the NHS focus to whole pathway, seamless care. Population Health Management (PHM) requires health services to think about the components of current and future health and care needs, which may be provided by a number of separate organisations, and work collaboratively to improve pathways and address the wider determinants of health.

Sharing the load

The NHS recognises the need to invest now to save money down the road. But the ever-increasing demand for services makes it challenging to reduce expenditure tor to fund investment in prevention, which may take many years to deliver on its aims. From our discussion, which included experts across several NHS Trusts, it was clear that this dilemma is the real barrier to progress, and an issue that Integrated Care Boards (ICBs) need to resolve.

When you add in the efficiency targets within the planning guidance and the reduction in COVID-19 funding, it’s hard to see how providers will be able to find further savings to invest in prevention.

As the financial belt is squeezed across organisations, they are more likely to revert to silo practices to balance their positions and all stakeholders will be seeking to maintain the inward fund flows. One answer is to better share resources. For example, can the contracts for transferring funds into bodies which pay for the resources be separated from the contracts on how those resources are used to deliver? In simple terms, paying for a resource would be to pay on behalf of the system, and the system could choose how best to deploy those resources which may be clinical staff, property or equipment.

For example, many physiotherapy sessions currently tak place on hospital wards, with the hospitals employing physiotherapists specifically for that role. A more joined up approach between hospital and community providers could see all physiotherapists managed collectively, irrespective of which organisation paid them. This workforce could then be flexible which would mean better patient continuity: ensuring people get their physio care at a convenient location and ultimately avoid further admissions to hospital.

The same could apply to diabetic services – if the acute and community teams worked together, and could move between settings, it would enable the clinicians to improve the pathways. Similarly, specialist consultants could run clinics at larger GP practices, thereby preventing hospital attendances and inter-organisational referrals. An out-patient clinic could be run from a GP practice without the need to cross-charge staff or rent and all the associated admin which comes with it.

A bird’s eye to worm’s eye view

At Civica, we’re focussed on helping understand the financial implications of population health with the key driver being data. High-quality data, which is collated, managed and used effectively, is the lynchpin of better decision-making and ultimately, better outcomes, within population health. We take patient level data across all health care providers within an ICS and aggregate it to gain visibility of not only the cost of delivering care but also exactly what resources were used.

These structured data sets include all the detail captured within the national cost collection, which means the population health platform can provide a ‘birds eye to worms eye view’ of the care provided to the population, right down to which drugs have been prescribed. The data can be aggregated or filtered according to the audience, and the data can be mined at incredible speed using Power BI tools.

We are also able to use this aggregated data to see where an individual patient is using the system for different services and with multiple clinicians, with the aim of providing a better experience for patients and reducing duplication – ultimately changing the way we deliver care.

Once the platform is in place, we can then look wider – bringing in data sets from other services to identify correlations with specific disease in areas such as education, crime, deprivation and housing. We can examine the root causes of health issues and provide empirical evidence to support investment to improve wider population health.

If you’re wondering where to start, the simple answer is with your costing data. Every NHS Trust has lots of rich costing data that can and will play a crucial part in you making the best decisions for patient care.

If you have ideas or questions on this topic, I’d love to hear them and look at ways we can help. You can also read a wider range of views in the full HFMA article here