Outcome based commissioning: getting it right from the start

Clinical commissioning groups and local authorities need to be ambitious and brave when changing how they contract with all providers to deliver outcome based care.

To achieve this, they need to set up the best environment for providers to support them in making change happen. Here’s how:

The power of patients and service users

User engagement pays dividends when developing new services. It is a vital component of the discussion between commissioners and providers.

Outcome based design needs user involvement from the outset − with a balanced view from commissioners and clinicians. Users must understand and challenge behaviours that drive provider and commissioner decisions; and users’ frustrations, hopes and ambitions must be heard.

Commit stakeholders to action

A documented commitment between senior leaders in commissioning organisations makes them focus on common goals − ultimately delivering safer, higher quality services and better individual experience.

‘Truly incentivising contracts requires more than 25 per cent of the contract to be linked to user outcomes’

Linking agreements to commissioning intentions gives providers greater confidence in the commitment to rapid change, while incentives for providers and commissioners must be examined and better aligned if the benefits of outcome based commissioning are to be realised.

Don’t assume − test

A procurement process starts long before the tender process begins. Working with providers on structured supply market testing will yield excellent information for commissioners, speed up the procurement process and reduce the risk of costly mistakes.

Market testing is a two-way process and provider engagement relies on clarity of the required outcomes, financial expectations and scope of the service. Smaller, local providers such as those in the voluntary sector may need support in developing their commercial skills if they are to participate effectively in the process. Commissioners can learn a lot from providers by challenging the art of the possible.

Enable innovation − avoid prescriptive requirements

Truly incentivising contracts requires more than 25 per cent of the contract to be linked to user outcomes. To make this happen, commissioners must work to improve the understanding of providers and support them in partnering, combining their innate strengths and developing efficient, innovative new offers.

The commissioner must hold back a tendency to intricately specify services. Instead, they should identify experiential and clinical targets, for example, and set firm parameters and principles for acceptance of clinical quality, delivery and commercial risk.

As more commissioners choose outcome based approaches, those with the greatest chance of attracting competition and achieving success will be those that invest time in planning and preparation.

Adrian Woolmore is a director in Capita’s health advisory business