New
assessment tool heralds breakthrough for healthcare service redesign
30 January 2009
Health economics is often seen as a blunt instrument that tends to work
against patient needs. As the desire to control healthcare budgets
becomes ever more pressing, can a new kind of assessment technology help
service commissioners find the Holy Grail of health provision — delivering cost savings and the best patient outcomes?
Health
economics has become the watchword for healthcare provision across
Europe in recent years. As the world faces up to recession, the
importance of applying health economics to service redesign is set to
intensify. To those expected to deliver healthcare and those hoping to
receive it, this will probably be perceived as a worrying development
because health economics is frequently seen as a method that tends to
subjugate patient outcomes to meeting budgetary targets.
A plan by
an English primary care trust (PCT) to introduce bonus payments to GPs
for not referring patients to hospital recently caused uproar amongst
patient groups who branded the idea as ridiculous and detrimental to
patient care. But whilst opponents were focussing on the wisdom — and
the ethics — of such a scheme, the fundamental importance of ensuring
patients get the most appropriate treatment whilst reducing unnecessary
and often expensive hospital referrals for those patients, was hardly
mentioned.
However, these latter objectives are actually at the heart of
the English primary care budgetary system called Practice Base
Commissioning (PBC) which came into force in April 2005.
PBC is a process which offers
large medical practices or groups of practices the opportunity to take
control of elements of the commissioning budget for their patient
populations. If these groups of practices manage to design and implement
more cost effective services then they get to keep up to 70% of
those savings to spend on behalf of their patients.
In general PBC
encourages the avoidance of hospital-based procedures (where
appropriate), not only because they are disproportionately expensive but
also because they may not necessarily be the best way to deliver
treatment to a patient.
Although PBC has strong
political support, as yet probably no more than 20% of English
practices are currently involved in service redesign. However, the Darzi
Report, published in June of last year and commissioned by the UK
Government to provide strategic direction for the English NHS,
re-emphasises the role and importance of PBC for the future of primary
care.
Pharmaceutical companies have
quickly come to realise that in order to be part of PBC and interact
meaningfully with locality commissioning groups they will need to
develop novel resources that can aid the service redesign process.
One
company in particular, LEO Pharma, has harnessed innovative technology
to partner PCTs and practice groups in service redesign in the field of
dermatology. It has developed a ground-breaking computer-modelling tool
to help those involved in the assessment, planning and provision of
psoriasis treatment in primary care make cost savings and, at the same
time, improve patient outcomes.
Called
Psoriasis and Me, the computerised resource was developed as a result
of submitting a Health Technology Assessment (HTA) to the Scottish
Medicines Consortium for one of the company’s most advanced products. It
simulates the impact over two years of the use of a range of topical
psoriasis therapies on patient outcomes and costs in a given primary
care setting.
The programme works by comparing specific local data
inputs — such as population size, waiting times for referrals to
secondary care and the types and costs of treatments currently in use — to stored country-specific information and the Psoriasis Area and
Severity Index (PASI 75). It then generates a report which calculates
the optimum financial savings that could be made in a service redesign
which would also improve patient outcomes using the most effective
treatments.
Co-developed in the UK by LEO Pharma and specialist health economics and
outcomes research company Amygdala Ltd,
Psoriasis and Me has been piloted with English service providers for
the past twelve months and has already received a glowing endorsement
from the UK’s National Association of Primary Care (NAPC): “We commend
this resource to commissioners and providers in primary care. The
tool evaluates the most appropriate management of psoriasis within
primary care as well as current service effectiveness where costs can be
significant but, historically, have not been subject to detailed cost
analysis.
“In NAPC’s
view, one of the real advantages of Psoriasis and Me is that it helps
clinicians ensure that people with psoriasis receive the right treatment
at the right time and that patients are only referred to scarce
specialist care when necessary. Such a tool supports PCTs, PBC consortia
and practices both in commissioning and providing. Another potential
beneficiary of the resource would be the new Integrated Care
Organisations, when they have been approved by the Department of
Health.”
The
programme has also received extremely positive feedback from clinicians
who have seen it in operation with actual patient populations. Keith
Freeman, a UK Consultant Dermatologist with dual responsibility for
services in a primary care trust and a foundation hospital trust in the
North-East of England, sees the programme as a very welcome and valuable
aid for local decision making.
He said, “The priority for service commissioners
in treating psoriasis is to achieve the best pathways of care — to make
sure that the right patients are being treated in the right place at the
right time for the best possible outcomes. Treating effectively in
primary care is better for the patient — not so stressful, less
disruption to their normal life and no lengthy journeys — and also means
secondary care resources can be focused on the most appropriate cases.
Reviews help to encourage positive discussion which may not have
happened before. Tools like this are the way forward to help clinicians
review services, optimise care and keep better control of costs.”
The
Psoriasis and Me pilot has also revealed the extent to which healthcare
providers in England were unaware of the sizeable sums being spent on
treating psoriasis and the extent of early and expensive hospital
referral. In Keith Freeman’s area of operation, the number of first
outpatient referrals for skin problems exceeds referrals for all other
non-surgical medical conditions and he acknowledges the need for major
change. “In the recent past dermatologists were mainly hospital-based so
had a tendency to want to bring patients in for treatment and there was
very little communication with primary care. Things are now moving;
there is more discussion and a more patient-centric approach which looks
at the patient’s needs first and foremost. However we still need better
tools to help us deliver that approach whilst keeping budgets in mind
and this is definitely a good tool.”
As a result
of its unique way of comparing the outcomes of alternative treatment
options to an existing regime, Psoriasis and Me
has also shown service commissioners a strong opportunity to make
significant savings in their budgets which could run into millions of
pounds if replicated across the entire country.
“The programme has
already shown that as a result of more effective prescribing for
psoriasis in an English primary care population of, say, 250,000, yearly
savings could be as high as £277,000,” said Peter Jackson, Commercial
Development Manager for LEO Pharma UK, who has been working on the
Psoriasis and Me project from the start. “If
you extrapolate that kind of result to the UK population as a whole
(c60million people), the potential annual saving could be as much as
£66million. And with the current pressures on healthcare budgets that’s
the kind of saving that’s hard to ignore.”
LEO Pharma is apparently now
working with Amygdala to develop the programme for
use in psoriasis management in a number of Northern European countries,
with a potential roll-out in the next two years.
The
involvement of information technology in healthcare management has
recently had some unfortunate set-backs, as systems fail to live up to
expectations or just fail altogether. However, this development offers a
much more positive prospect to those involved with healthcare
commissioning and planning. Indeed, the implications of the
development of such a sophisticated assessment tool go way beyond
improved care for psoriasis patients; they seem to offer healthcare
providers the very real prospect of a way to reconcile the previously
divergent goals of minimising cost and maximising patient outcome in
service redesign.