From Clare Allcock | The Health Foundation
Outcomes-based commissioning is all the rage in the NHS. Many clinical commissioning groups (CCGs) are seeing it as currently the only viable commissioning route to deliver on the vision set out in the Five Year Forward View; 2014’s HSJ ‘CCG barometer’ showed three-quarters of the 109 CCG leaders who participated thought it was likely or very likely they would re-contract a significant amount of spend under an ‘integrated’ contract covering a defined population.
Hang on. Let’s rewind. What are we talking about? ‘Outcomes-based commissioning’ describes an approach to health care commissioning based on outcomes (unsurprisingly), but also the use of a population approach, metrics and learning, payments and incentives, and co-ordinated delivery across providers. It’s these five components together which make up the concept – as such ‘outcomes-based commissioning’ can best be thought of as a brand name rather than simply a description.
So is it the panacea we’ve been looking for? A lot is said about international examples of success with the ‘Alzira’ model used in Valencia being oft quoted by Jeremy Hunt as something the NHS should be moving towards. Colossal claims abound: McKinsey have forecast a saving of ‘a trillion dollars’ in the United States over the next decade for the successful roll-out of an outcomes-based payment model in government health care spending. However if you dig a bit deeper you find that the evidence for outcomes-based commissioning reflects its relatively recent history in health care; while evidence exists, it is limited in scope and strength. And certainly in England, there are as many cautionary tales as there are success stories.