Right Care Deep Dives
NEW Devon CCG
Blood Disorders
Contents
1. Introduction
• Right Care Deep Dives, Unwarranted Variation, Using the Evidence
2. Deep Dive Methodology
• Data Extraction and Processing, Analysis and Presentation
3. Deep Dive Findings: Blood Disorders
• The Challenge, Population, Activity/Spend, Outcomes, Opportunities
• Who’s Doing Well? What Does This All Mean?
Introduction: Right Care Deep Dives
• Commissioning for Value packs help identify Programme Areas in which to
look
• Analytical Deep Dives form part of phase two: ‘What to Change’
• Further, specific analytical requests would also support the ‘How to
Change’ phase
Commissioning for Value Packs
Where to look
What to change
How to change
Deep Dives
Deep Dives
Deep Dives
Deep Dives
Introduction: Unwarranted Variation
• Aim to understand what can’t be explained by patient choice or
illness of population
Commissioning for Value Packs
Where to look
1
1.
2.
What to change
How to change
Deep Dives
Deep Dives
Deep Dives
Deep Dives
2
AIdentify
four-stage
Variationprocess
Identify the variation
Understand if it is
warranted
Understand if it's warranted
3
3.
What's
it?
Whatdriving
is driving
4.
4
How
doeliminate
we eliminate
How
do we
it?
it?
it?
Introduction: Using the Evidence
Using evidence to move from:
“How can I explain this?”
to
“What can I do to improve this?”
Methodology: Data Extraction and Processing
• Downloaded data for NEW Devon and comparator CCGs from a host of
national sources:
o
o
o
o
o
Programme Budgeting
HSCIC/iView Prescribing
Quality and Outcomes Framework
Public Health Profiles
Many more!
• Process this data into formats which allow ease of comparison and further
analysis
Methodology: Analysis & Presentation
Focus on key areas
and/or indicators
Present comparative
data against different
scenarios
Review data at a range
of levels to better
understand variation at
a macro and micro level
• Where NEW Devon CCG is:
• In ‘worst’ quintile
• Where a related set of indicators show a tendency toward poor
performance
• National median
• Median of national upper quintile
• Median of ‘most similar 10 CCGs
• Median used instead of mean to reduce impact of extreme outliers
• Against national position and benchmarks
• Similar CCGs
• Provider
• Practice
Methodology: Analysis & Presentation
• Inquiry approach
– Exploring data using key lines of enquiry (KLOEs)
– Identify ‘golden threads’ present throughout the data
– Working with partners to understand local issues
Identify poorly
performing area for
KLOE using
programme
budgeting as a base
Review related
indicators from other
data sources to refine
detail
Analyse provider and
practice level data to
illustrate local
variation
Assess scale of
opportunity against
various scenarios
Blood Disorders Programme
Areas for investigation
Anaemia
Thalassaemia
Sickle cell disease
Aplasia
Abnormality of
white blood cells
Disease of the
spleen
Abnormality of
plasma protein
Immunodeficiency
with antibody
defects
Thrombocytopenia
Coagulation defects
& deficiencies
Abnormality of red
blood cells
Sardcoidosis
The Challenge
• CCG in second highest
quintile for spend in four of the
nine areas
• Outpatient activity is the
largest driver, although picture is
complex
• In some areas there may be
opportunities to negotiate local
tariffs with providers to help
drive down costs
Population
• Low levels of ‘at-risk’ groups for certain blood disorders
• High levels of chronic disease which may increase risk of certain
blood disorders
Primary Care Prescribing
• Spend in second lowest quintile nationally
• Opportunity for savings is relatively low and limited
detailed information available to support
• Addressing practice variation could help deliver the
small opportunity in this area
Opportunity = £0 - £107k
Community and Integrated Care
• Data suggests potential opportunity for savings when compared to
similar CCGs
• Lack of detail available about what drives this
• It could be that high
spend in this area is
supporting relatively
low levels of Non
Elective and A&E
spend
Community and Integrated Care
Opportunity = £1.4M - £3.3M
Outpatients (1)
• Outpatient costs in second highest quintile
• Significant variation across CCGs which may indicate differences in
recording practice
Outpatient Opportunity = £320k - £2.3M
Outpatients (2)
• NEW Devon shows a high proportion of activity recorded under
Clinical Haematology attracting a mandatory tariff
• Anticoagulant Service are subject to local cost agreements
Inpatients
• Non Elective spend benchmarks well
• Elective spend within middle quintile showing some opportunity
• Some of this could be delivered through changing the setting of care
for Day Case activity
NEW Devon
10 most similar
CCGs
England
Ordinary admission
5%
4%
6%
Day Case
94%
90%
83%
Regular Day
0%
6%
11%
Regular Night
0%
0%
0%
Point of delivery
Inpatient Opportunity = £30k - £594k
Unbundled High Cost Drugs and Devices
• CCG spend falls within the highest national quintile
• Limited national data available to understand the detail; local
analysis recommended
Reduction scenario
Spend per 100,000
(£000s)
National median
35.8
Difference with NEW
Devon spend per
100,000 (£000s)
22.0
Saving opportunity
(£000s)
National best quintile
median
7.0
50.8
460.2
Similar 10 CCGs
median
29.3
28.5
258.3
199.8
Unbundled High Cost Drugs and Devices
Opportunity = £200k - £460k
Opportunities
•
•
•
•
•
Primary Care Prescribing: £0k - £107k
Community and Integrated Care: £1.4M - £3.3M
Inpatients: £30k - £594k
Outpatients: £320k - £2.3M
Drugs and Devices: £200k - £460k
Overall Blood Disorders opportunity: £1.95M - £6.76M
Who is doing well?
Outpatients
Gloucestershire
CCG
Dorset CCG
Windsor, Ascot
& Maidenhead*
Community and Integrated
Care
South
Derbyshire CCG
Nene CCG
Mansfield &
Ashfield CCG*
CCG performance based on age-sex standardised information
*not a peer CCG, but best-performing CCG in country
What does this all mean?
• Significant opportunity in Community and Integrated
Care  Would need careful consideration as this
could be contributing to low Non-elective and A&E
spend (*peer CCGs with low Community spend do not have
significant Unscheduled Care costs)
• Opportunity in Outpatients is wide-ranging and
blurred by apparent coding disparities  would
require more-detailed review to understand
potential
• Elective/Daycase opportunity could be realised by
shifting setting of care to Regular Day Attender
Any Questions?