Background: Over the last 20 years, the NHS has introduced multiple changes in the commissioning structures, aiming at promoting integrated care in England. The Health and Care Bill 2021 is the latest and farthest-reaching reform, under which local commissioners from the emerging Integrated Care System (ICSs) are expected to accelerate the implementation of ‘integrated care programmes’. This overhaul demands local commissioners to develop approaches to robustly monitor and assess ‘integrated care programmes’ when making investment decisions. This research project aims to develop a framework to support the local commissioning of integrated care in England.
Methods: To understand the decision-context and identify the most relevant monitoring and assessment criteria, we conducted 26 semi-structured interviews with local stakeholders. To supplement the criteria and inform the development of the evaluation component, we conducted a systematic literature review on the use of multi-criteria decision analysis (MCDA) in healthcare. The monitoring component of the framework is based on key performance indicators. A system-adjusted time-trend is used to identify ‘integrated care programmes’ that underperform and consequently should be re-assessed. For the evaluation component, we develop a value-measurement MCDA. To define the relative importance of the assessment criteria on the basis of public values, we conducted a discrete choice experiment (DCE) with members from the public in England. In the DCE, participants are presented with two hypothetical care programmes, described by six attributes (assessment criteria), and are asked to state their choice. The design of this experiment was informed by the literature, local stakeholders, and representatives from the Oxford & Thames Valley Patient and Public Involvement group. Standardised performance scores will be estimated using routinely collected data and quasi-experimental methods.
Preliminary results: The emerging ICSs open an opportunity for local decision-makers to strengthen the commissioning process, and the proposed framework can potentially contribute to this end. In the interviews, stakeholders indicated that health outcomes, quality of care, cost and equity should be the main drivers of investment decisions. Similar criteria were used in 55 MCDA studies developed to guide priority-setting decisions in high-income countries, with most of these studies using the value-measurement approach. Intermediate health outcomes, compliance with national guidelines, quality of care and equity in access are defined as the monitoring criteria. The assessment criteria are six: final health outcomes, health-related quality of life, patient experience, size of the target population, equity and cost. According to the DCE conducted with 440 members from the public, the six attributes are statistically significant.
Apostolos is an Associate Professor in Health Economics at University of Oxford, where he is leading a programme of research that focuses mainly on the economic evaluation of new models of care, particularly for people with mental health and multi-morbidity, and financial incentives in healthcare. He is also is leading the Oxford Mental Health Economics and Policy (OMHEP) group. Apostolos has worked in several experimental and observational studies across a wide range of services for prevention, diagnosis and treatment in several clinical areas but mainly in mental health. He has raised more than £5 million in research funding for health economics mainly by British organizations (e.g. NIHR, Welcome Trust, Health Foundation, and local health authorities) and the European Commission.
He also holds a honorary contract with the Office for Health Improvement and Disparities (UK GOV) where he advises on matters related to mental health economics and policy, and he acts as a scientific advisor to the World Health Organization on topics related to health financing.
Apostolos has developed international reputation in these areas of research through more than 80 scientific publications and book chapters as well as numerous presentations at prestigious conferences. As a recognised expert in payments and financing of chronic care, he has given invited talks, keynote speeches, and advice to several governments (e.g. UK, Ireland, The Netherlands, Belgium, Estonia, and Australia) as well as to national (e.g. Royal Society of Medicine in London, NHS England, Diabetes UK, and Austrian Platform for Personalized Medicine) and international organisations (e.g. European Commission and World Health Organization). Apostolos’ work has received substantial attention in (social) media outlets and has influenced health policy and clinical guidelines (e.g. the Early Intervention in Psychosis Programme of NHS England, and the Cervical Cancer Screening Programme of Public Health England).
Apostolos has co-developed, coordinated, and taught in numerous undergraduate, postgraduate, and professional courses in health economics in Oxford and Rotterdam and has supervised several postgraduate students. Apostolos holds editorial positions in several scientific journals, he is member of several committees, and he is a Research Fellow at Oxford's Green Templeton College.
Link zoom: https://unibocconi-it.zoom.us/j/92311690674?pwd=eVRwWkdKRFUrc0Zkd0taUncyL1pRdz09
Meeting ID: 923 1169 0674
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