Commissioning Opportunity (COP) - Rules Based Expert System

i5 Commissioning Opportunity module (also known as COP) facilitates transformational change by evaluating hundreds of successful healthcare initiatives at patient level to calculate their value for a specific organisation - be it a CCG, Locality or an Acute Trust. Metrics for each initiative are based on clinical parameters developed with commissioners, hospitals, clinical staff and other HCP. A case study on how the COP is used in practice is shown below.

Matching Patients to Interventions

COP matches "successful" interventions to patient groups using "clinical signatures" to facilitate identification of care gaps in pathways or development of new models of care for a local health economy. The diagram below set's out the ongoing process we have adopted to develop a rules based Expert System for healthcare transformation and restructure.

i5 Health has researched thousands of case studies from the NHS and evaluated their impact using a Population Health Management (PHM) approach and extracted the clinical signatures of those patients that would benefit the most. Those clinical signatures present the rules base for the i5 Health Expert System.

Those clinical signatures can be applied to activity data relating to a health economy of any size to identify the most suitable services and interventions for this case-mix. This is performed by matching the clinical signatures of patients to the signatures relating to services and interventions. The better the match, the more the patient may benefit from the service or intervention.

Once a set of services and initiatives has been identified, they can be grouped into pathways by condition, arranged by setting or categorised into a new model of care for impact analysis and simulation. The COP simulator enables users to set up an unlimited number of scenarios based on different services and interventions to model capacity, demand and workforce requirements. The image below shows a urgent care simulation set-up.

Options Evaluation

The recommendations of the Expert System greatly support the "cross-organisational" planning process for health economies by providing an unbiased view of the patients' needs. The application of a rules based approach also supports co-operation with neighbouring organisations since all patient needs are identified consistently. This facilitates the development of place based planning for shared services and continuous monitoring of service performance at each site.

The i5 Health Commissioning Opportunity (COP) facilitates transformational change by evaluating hundreds of successfully implemented healthcare initiatives by the NHS at patient level to identify patient cohorts that would benefit from an initiative. Metrics for each initiative have been developed with commissioners, clinical staff and other HCP in an exercise initially set up to reduce NEL admissions and has been extensively expanded since. It supports Place Based Planning, QIPP, BCF, CIP, Co-Commissioning etc. planning activities for both one year operational plan and five year Sustainability and Transformation Plan (STP) and can also be used for constant monitoring of initiatives. The diagram below shows a typical COP report.

COP can be delivered as a one-off report to facilitate planning and as a system to support continuous monitoring. The diagram below shows an example of the reports contained in the reporting package.

Case Study - Planning Support for Halton CCG

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Urgent Care
Last year we needed to map out the Urgent Care pressure across all the supporting Hospitals. Linked with this exercise, we commissioned i5 Health, using the Commissioning Opportunity module (COP), to investigate the patient urgent care journey. COP is all about matching patient groups against successful healthcare initiatives and forecasting the effect of local implementation on patient care and our budgets.
At the time, we went on record saying that i5's analytical and economic approach gave Halton a unique view into what financial results could be made – particularly through our local partnership approach. "Unlike any other piece of consultancy, i5 Health and COP shone an economic light on what schemes are working well and what areas we could prioritise our energy on". A proof of the quality of their work lies in the positive and accurate effect they predicted would arise from the creation of the UCCs.

We then asked for the assistance of i5 Health in analysing our significant Readmissions issue. Their analysis, based on their COP algorithms, got right to the heart of the problem and identified a significant number of patients that, under normal circumstances, should not have undergone readmission. The responsibility of key clinicians was also highlighted. i5 Health went beyond problem identification and evaluation and made detailed and well considered recommendations – not just for us at the CCG but also our providers and our colleagues across primary and community care.

Outpatient Procedures
More recently, i5 Health did a deep dive into what has been happening in respect of OP and then came up with some solutions to excessive use in Cardiology, Mouth/Head/Neck & Ears, Orthopaedic Non-Trauma and Urology. Those solutions included alternatives for 6,000 procedures currently costing us over £1.5m.

ACSC - Respiratory and ENT
The latest piece of work by i5 is around what might, currently, be the best opportunity for Halton to reduce acute care activity and cost - dealing with Respiratory and ENT conditions. Besides analysing our historic and current situation, they dug into six case studies to establish, using a Population Health Management approach, what might be optimum strategies for us to pursue. One of the many positive outcomes of the exercise has been the identification of over 200 patients clinically diagnosed with COPD in secondary care that are not on the GPs risk register and which are likely to be unmanaged.