A pioneering project
This pilot for the NHS driven by 'Payment by Results' is a joint venture between the West Midlands Strategic Health Authority (WM SHA) and QISMET.
NHS West Midlands is dedicated to supporting the public to make healthier, more informed choices and has committed to invest in providing personalised information and services that motivate people to stay healthy. A rapid increase is required in the range of services and number of suppliers that provide both the time and the structure for individuals to understand their health risks and then take action to reduce their risks.
NHS West Midlands believes there is a sound economic case for increasing the supply of upstream (preventative and self care) interventions. To bring about an increase in supply, they have advocated the introduction of standard currencies, tariffs and market rules for these services. A number of West Midlands PCTs agreed to adopt this approach for the Chronic Disease Self Management Programme (CDSMP) from October 2009.
Seven providers (who were sucessfully accredited via the first round of the West Midlands Tariff procurement process) were audited in the spring of 2011 and were the first organisations to become QISMET certificated.
How it works
From 1 April 2010, self management programme providers in the West Midlands which have successfully completed the West Midlands SHA (WM SHA) accredited provider procurement process, have been free to recruit eligible participants, deliver the CDSMP, and claim a payment from the responsible PCT.
The payment is at a standard tariff rate upon the achievement of a specified output or intermediate outcome. The WM SHA accredited provider, must keep adequate records to allow their activity to be audited, and must deliver the service to an agreed specification.
To ensure high quality management and delivery of the CDSMP the WM SHA accredited provider organisations must achieve QISMET certification within 12 months of the commencement of their contract. Those not who have not successfully acheived QISMET certification by this time will be considered to be in breach of their contract and may have their contract terminated.
Participating PCTs in the WM SHA Project undertake the accredited provider procurement process every six months, with the successful applicants being announced in April and September.