How a Population Health approach can transform QIPP to improve outcomes for patients

Attain’s approach to Population Health is a practical set of tools to have an impact this financial year not a theoretical framework for the distant future. At the heart of our approach is the patient and delivery of quality, cost efficient care. Here we discuss how Population Health can be successfully applied to common problems, such as QIPP.

The four key components of QIPP

QIPP (Quality, innovation, productivity and prevention) is a broad  programme of work, launched by the Department of Health in 2009, with the aim of increasing quality whilst reducing cost. The theory behind this (from the American Institute for Healthcare Improvement) is that boosting efficiency will also improve the quality of care that patients receive. The intention of the Department of Health was that commissioners and providers would assess a range of health system interventions against the four components of QIPP, in an attempt to avoid unsustainable ‘slash and burn’ cuts.

However, since its inception there has been concern from managers and clinical and operational staff that QIPP has become shorthand for cost cutting, particularly against a backdrop of stretched NHS finances. We have seen many current QIPP schemes tending to focus on costs at a service level at the expense of investment in improving quality and prevention.

As a result of this narrow focus on services and costs, current approaches to implementing QIPP aren’t always person centric; they often focus on specific services rather than the people using them and the financial impact of changing services rather than the impact on quality. For example, taking a service level approach to cutting spending may mean that an individual with complex needs may receive more fragmented rather than integrated care. We also recognise however, that cost pressures exist and that QIPP can be used to relieve these pressures if delivered in a considered way.

A Population Health Approach: A patient centric lens

Attain has developed an exciting new population health based approach to QIPP, that enables the full potential of quality, innovation, productivity and prevention to be realised, without compromising on cost savings.

Population Health is an increasingly important lens with which to view the delivery of NHS services and likely to be a corner stone of the upcoming NHS 10-year plan. It takes a whole population focus to tackling the drivers and outcomes of poor health across a given geography, with patients’ needs at its heart. This is a patient centred approach with prevention at its core, that can potentially transform health services by driving cost efficiency without compromising quality of healthcare.

What does a Population Health approach involve?

Our Population Health approach has been developed working across the health and care sector to deliver sustainable impacts for patients. Our work has involved:

Population segmentation: Looking at the whole population in an area and defining distinct patient segments and groups of citizens defined by the health services that they need. For example, these groups could include children and young people; people with learning disabilities; people with long term conditions; frail people etc. This segmentation will necessarily be defined in part by available data sets and Attain has experience of defining these on a local basis, making use of existing risk stratification in primary care.

Data set analysis: Reviewing the services and associated volumes of activity that each segment of the population receives, giving an overview of variation and insight into equity of service delivery. This could mean reviewing all acute, primary and community activity commissioned by the NHS for frail people in a given area. Analysing integrated, population level data sets for this work allows us to see how a group of individuals consume healthcare resources over time.

Activity benchmarking: Benchmarking activity analysis with other parts of the country that have similar levels of need allows us to identify areas of overspend and opportunities to drive improvements to quality, linking to Rightcare and Getting it Right First Time.

Intervention planning: A range of interventions will then be developed based on this analysis, together with local expert input and proven innovation and best practice. These could include;

  1. The reduction in duplication of services which have a benefit on overall quality of service as well as on reducing provider overspend.
  2. Co-location and integration of services aligned to the needs of a population segment which can lead to workforce productivity gains

Reinvestment: The savings generated from interventions will enable a health system to release money to focus on prevention, aimed at these specific population segments, with the aim of slowing progression of conditions and contributing to further savings from reduced activity in later time periods. This is currently doesn’t happen but is likely to be part of the NHS 10-year plan, where commissioners will be given the freedom to reinvest, which can be written into the upcoming 5-year plans. Using a patient segmentation approach is particularly useful here as we can see how people progress between segments as they age, giving us the opportunity to see the real impact of prevention intervention and using new contractual models to ensure sustainability.

What’s next?

This work ideally requires data that spans across providers, linked by patient ID. However, if this isn’t possible, some of these insights can be delivered with single provider data such as acute SUS data, if we have sufficient accompanying demographic descriptive data.

In summary, this approach seeks to reiterate the four key components of QIPP and deliver sustainable efficiency and quality gains that support cost containment strategies. Attain’s novel approach to an old problem can deliver benefits to patients, whilst relieving financial pressures faced by health systems.