Supporting Clinical Commissioning

Improve the quality of care for patients and drive cost efficiencies. 

We use a data-driven and evidence-based approach to improve the quality of care and drive cost efficiencies, giving commissioners and providers the information they need to make the right decision for patients at the right time.

Optum provides support for commissioning services in a range of areas, including:

  • Analysis and presentation of data to design services, plan budgets and deliver care around patient need
  • Delivery of commissioning support services, such as improved contract and   performance management and payment accuracy
  • Development of integrated care solutions to provide joined-up and personalised care
  • Operational commissioning, e.g., referral facilitation and technology
  • Improved quality in medicines management and prescribing
  • Outsourcing of back office, commissioning support and business intelligence functions

Described by the NHS as a comprehensive approach to commissioning. We provide support across a number of areas, including: 

Contract negotiation with acute providers

Optum can provide you with end-to-end support through your contracting process, from capacity planning through to negotiations with providers. We work with our clients to issue progressive commissioning intentions such as reductions in readmissions, targeted prior approvals processes and thresholds for high-cost drugs.

Finance and performance management

We use tools such as our Data Diagnostic and Case Note Audit to help manage activity against negotiated contracts and monitor adherence to evidence-based pathways. We will quickly identify accuracy of coding from providers and provide support in the contract challenge process. We will support you to reinforce contractual requirements — such as the provision of data in the required format.

System and service redesign

We will work with you to identify areas for prioritisation and focus, using a data-driven and evidence-based approach. We draw upon our international experience to evaluate current systems, benchmark against national and global best practice and implement service improvements.

Commissioning and engagement

Our knowledge and experience as commissioners means that we understand the importance of effective and ongoing engagement. We will help you with a range of engagement activities, from prioritisation through to self-care and shared decision making. We can also help you with your internal engagement — driving improved commissioning through GP practice engagement with your Clinical Commissioning Group vision, targets and objectives.

Data diagnostics audit

A clinically led team undertake data analyses and review (as a minimum) of SUS and SLAM data to identify areas which require clinical coding assurance, review of ”outlying” or inappropriate practice and/or individual patient case note review. Data analysis and review can be undertaken to inform a rapid care pathway diagnostic to identify areas with greatest potential for realising savings. Initial data analysis provides guidance to the team regarding identifying the need for and means of undertaking a more detailed assessment. Savings are realised through a variety of means including identifying errors, providing evidence to support contract challenges and agreement of new contracts.

Long term condition management

Optum provides integrated care models that allow gaps in care to be identified and addressed more easily, resulting in improved quality of care for patients. Our aim is for commissioners and providers to ensure patients receive the right care, through the most efficient service delivery model, at the right time. Our programmes deliver tangible results — for example, our integrated health and social care model for North East Lincolnshire Care Trust Plus saved more than £1.7m in the first recorded nine months.

Healthcare intelligence and analytics

A critical success factor for any commissioner is to transform the large amounts of data and information into knowledge to drive decision making. Our organisation operates the largest health care database in the world with more than 300 terabytes of data. Our team of experts includes health economists, actuaries, informatics professionals, medical doctors and business analysts. They can support you in ensuring that the data about your population can provide you with a reliable evidence base to inform the key decisions affecting the health and well-being of your population.

Referral facilitation and technology

We provide referral facilitation services and technologies that are delivered to support GPs and commissioners. Our solutions deliver increased treatment options for patients and reduced administrative burden for referrers. We share feedback on referralpatterns and support sharing of good practice between GPs — leading to reduced unwarranted variation in referral practices. We also deliver supportive GP education programmes, reducing errors in referrals that lead to delays in patient care.

Medicines management services

We provide GPs with national and locally authored patient safety information messages, drug switch recommendations and dosage optimisation information. Our ScriptSwitch® software is currently used in 7,500 GP practices, across more than 140 Primary Care Organisations, delivering the NHS savings of £40m per year. We can help you monitor the performance of your practice and run reports within the ScriptSwitch Analytics tool. You can review ”real time” ScriptSwitch data that provides intelligence that can be used to further educate prescribers and identify additional cost benefits.

Annual savings

£17.4m annually recurrent savings resulting from our comprehensive approach to commissioning

Working with more than
  • 140 Primary Care Organisations and
  • 24 Clinical Commissioning Groups
Benefits of clinical commissioning support services from Optum:
  • 1,291 avoided visits to A&E
  • 504 avoided emergency hospital admissions
  • 346 avoided permanent care home placements
    …delivered by one integrated health and social care programme