Use of patient level costing data: establishing value based public health care in England

The public healthcare system (NHS) in England is going through major policy changes, leading to develop new payer organisations (Clinical Commissioning Groups) and allowing pluralistic providers to deliver services. This is meant to achieve high quality low cost (value-based) healthcare, at a time when NHS is facing £20 billion budget gap, to meet the needs of its population. Patient level costing data is fundamental to develop clear understandings of resource utilisation and outcomes (quality/variation of services) for the mutual benefits of payers and providers. It also helps to build effective partnerships between clinicians and finance managers to establish value-based healthcare. In spite of the national policy, to encourage all acute healthcare providers (trusts) to collect systematic and reliable patient-level costing data, not many trusts in the country were able to implement and use Patient Level Information & Costing Systems (PLICS) effectively. Therefore, we decided to;- Establish the current state of PLICS implementation in the NHS - Explore the views of clinicians and finance managers about its potentially achievable benefits, issues related to implementation and identifying example of best practice where PLICS helped to deliver value-based healthcare services. We conducted three surveys to gather the required information from acute trusts in England;- Survey 1: Questionnaire sent to 167 acute trusts to establish the level of implementation (implemented/implementing/plan to implement) - Survey 2: on-line survey of Director of Finance of acute trusts- Survey 3: on-line survey of lead clinicians from the acute trusts The results helped to understand the current state of implementation and develop pragmatic knowledge of the uses of PLICS by analysing the clinicians and finance managers responses;Key findings:- Response rate = 92%- 68% have implemented or implementing PLICS - Main benefits:o Cost improvement through enhanced technical efficiencyo Understanding clinical variation in resource use and the relationships between cost and qualityo Greater clinical engagement through more clinical ownership of costs and information systemso Evidence-based performance reporting & benchmarking- Barriers/Issues in using PLICS data:o Insufficient awareness across the organisation o Poor presentation of financial datao Lack of basic finance skills among clinicianso Lack of formal mechanisms of joint working between clinicians and finance managers- Example of best practice:o 12 examples of best practice were identified, where both payers and providers used PLICS data to improve quality and efficiency together The conference theme has highlighted the importance of current financial challenges faced by European healthcare systems. The notion of ‘who pays and who provides’ needs to be underpinned by cost and quality relationship i.e. what cost payers pay to get high quality services from providers. A clear and in-depth understanding of patient level costing and related outcomes can provide opportunities to develop value-based public health care systems in Europe. PLICS is a relatively recent innovation in the NHS. It is a method to record all significant activities happen to individual patient from the time of admission until the time of discharge and calculate the resources consumed by using actual costs incurred by the organisation. Therefore, our research on PLICS has identified benefits, barriers and pragmatic use of patient level costing data. It provides ideas to deal with European healthcare management challenges, through joint efforts of payer and provider organisations.