Case Study

Continuing Healthcare Saving in Eastbourne

Eastbourne CCG case study: we achieved savings of £250,000 from the domiciliary care budget in one year

How? Using our Caretrack database for continuing healthcare information, we scrutinise and manage payment of domiciliary care invoices, identifying and avoiding many examples of over-charging.

Context

We first started working in Eastbourne in 2010, when our Caretrack database was purchased and we were also commissioned to manage payments for FNC (funded nursing care) clients.

Caretrack and our invoice management service was well received and in October 2012, our remit was extended to cover the management of all invoices for all continuing healthcare (CHC) patients funded for domiciliary care.

The Issue

Domiciliary care for CHC clients involves a high budget with a high level of complexity. There is wide variation, not only in terms of care delivered, but also with different rates being paid for different times of the day. Without robust and reliable information systems, CCGs are likely to be over-paying for domiciliary care, without a robust system in place to verify invoices.

Robust and reliable CHS information systems

It is essential to know that you have your own robust, reliable and up-to-date information systems. Caretrack holds all relevant information concerning a CHC/FNC patient. As well as standard identifying information, it also includes:

  • Extensive Reporting (including Financial Outturn forecasting and the Quarterly Funded Care Return) and Care Provision.
  • A Care Module that allows any number of providers to be allocated to a patient concurrently, with different cost types and start/stop dates all individually recorded as well as costs. Thus one can look back to any day in history and see exactly what the commissioned cost for a patient was on that day.
  • Caretrack supports multiple ‘Funder’ types (ie CHC, FNC) so when a patient’s eligibility changes (even retrospectively following an appeal), it is a simple job to define the date when funding changed.
  • As well as such detailed information on Commissioned Care Cost, Caretrack has a ‘Payments’ function which records all payments made to Providers, linked to the Patient and a specific episode of care

Principle of scrutiny

This means that the Caretrack system will always provide an accurate calculation of cost of domiciliary care for each patient. So when invoices are received from providers, they are compared with the Caretrack calculation. If invoices are above the Caretrack calculation, further checks take place (normally calling the provider) to find out why there is this discrepancy. To support this, providers are made aware of the process they need to follow in the event of a patient requiring a variation to the commissioned care in place to meet the assessed need. The principle is that the Caretrack record is correct; if provider invoices do not match, there must be scrutiny.

In addition to this principle of scrutiny of every invoice, we call care providers every week to check what care has been provided and update the Caretrack database accordingly.

Examples

An invoice is submitted for £350. Caretrack records show the invoice should be £250. The provider is called and states that care was originally commission at the level of £350 a week, but the patient now has slightly lower needs. The provider continued to issue invoices at the original level. Before the scheme started, there was a lack of data to identify and challenge this pattern.

Care needs can also increase over time. For example, an invoice is issued for £450, although Caretrack records show the amount should be £350. This can be due to the patient’s needs increasing and in some cases, providers would simply increase hours provided and invoices submitted. Under our scheme, increases in care provided must be authorised by review, thus creating stronger CHC governance and ensuring that any potential clinical risks are reviewed and responded to.

Additional savings benefits

In addition to the savings we achieve from identifying and clarifying invoices, there is also the benefit of clinical staff being freed up from dealing with providers and their invoices. This can be very time-consuming, removing nurses from clinical work and using a high level of staff resource. If CCGs are not confident in their own information systems, particularly if there is a complex care record for a patient, there can be a tendency to pay invoices, even if they are unsure whether they are correct.

Our service works because we start with a baseline of accurate, robust information systems and focus wholly upon this area, freeing staff to concentrate on the clinical management of CHC patients.

Widely commissioned

This scheme is not only commissioned in Eastbourne. We provide the same service in Wiltshire, Brighton, Hillingdon, Ealing and Hounslow. With this experience, we can confidently predict that we will deliver savings of at least five per cent of your total domiciliary care budget during the first year of the scheme. This equates to many hundreds of thousands of pounds.