Bespoke Extract Request for producing benchmarks within products

Optum Health Solutions UK Limited is a health services and innovation company which aims to improve the quality of health care in the UK by providing provider contract management, administrative, financial and business intelligence services to many types of NHS Organisations (Optum Health Solutions UK Limited do not provide services outside of NHS Contracts for the aforementioned tasks). Optum Health Solutions UK Limited requires data from NHS Digital for the purposes of the legitimate interests described in this section.

The purpose of this application is for the provision of SUS PbR data required for the development of four Optum Health Solutions UK Limited products. In this capacity Optum Health Solutions UK Limited is the data controller. Outside of this application Optum Health Solutions UK Limited also work as a data processor to support the contracting and commissioning function for a number of CCGs. Data will be turned from historical activity into insightful analytics by encompassing a variety of statistical techniques, including actuarial modelling, predictive analytics and data mining. Optum Health Solutions UK Limited will explore current and historical facts to bring insight and make predictions about future, or otherwise unknown, events. Optum Health Solutions UK Limited in its capacity as a data controller under this agreement will provide insights and intelligence through the development of the four products:

PRODUCT 1 - the population health analytics tool Health Population Manager (HPM),

PRODUCT 2 - the Commissioning & Contracting suite (CCA),

PRODUCT 3 - the Horizon tool and

PRODUCT 4 - the Population Health Management (PHM) Strategic Modelling Product.

Optum Health Solutions UK Limited work with many types of NHS Organisations and NHS organisations working in conjunction with STPs and ICSs, including:

- Commissioning on behalf of 25+ CCGs

- STPs and ICSs

- Process data from providers across the country for both commissioned and Non Commissioned Activity (NCA)

- NHS England National Commissioning Capability Programme (CCP) partner organisations, and RightCare* Teams

- 3 DSCROs

- 2 Commissioning Support Units

- GPs across England and Wales

The typical use for the four tools mentioned above are by organisations that have a statutory commissioning function.

* What is NHS RightCare?

NHS RightCare features in the 2019/20 Operational Planning and Contracting guidance which covers system planning, the financial settlement, operational plan requirements (for primary care, workforce, data and technology) and the process and timescales around the submission of plans. The NHS RightCare teams work locally with systems to present a diagnosis of data and evidence across that population. NHS RightCare Delivery Partners and their teams work collaboratively with systems to look at the evidence to identify opportunities and potential threats. Using nationally collected robust data, this collaborative working arrangement helps systems to make improvements in both spend and patient outcomes.

Optum Health Solutions UK Limited requires national SUS PbR data to develop and use the four following products:

PRODUCT 1. Health Population Manager (HPM )

HPM provides a year on year analysis of spend by specific disease categories and conditions. HPM has the ability to filter and highlight areas of concern through the use of graphical visualisation of activity and spend. The HPM tool allows the commissioners of care to target a specific cohort of patients in order to provide better quality of care and track financial spend for a specific Provider, CCG or GP Practice. Commissioners can use easy-to-understand benchmarking, using national SUS Pbr data, to compare against similar organisations to help better understand their performance and to ensure they are focused on the right areas.

PRODUCT 2. Contract & Commissioning Suite (CCA)

CCA provides a method for processing SUS PbR data and adding meaningful fields that enhance the data prior to being consumed by other tools for analysis. CCA is also the platform used to prepare data for downstream reporting and applications such as HPM, Horizon and Population Health Management (PHM).

An example downstream reporting includes CCGs who need to identify Quality, Innovation, Productivity and Prevention (QIPP) initiatives to improve the quality of care they deliver while making efficiency savings that can be reinvested into the NHS.

The Optum Health Solutions UK Limited team also provides reports to clients after analysts have analysed the data and added interpretation and insight.

These benchmarks are proportions from aggregate numbers produced at various levels from diagnosis and procedure combinations to Healthcare Resource Groups and Episode Treatment Groups. An example might be the proportion of all non-elective admissions that have a length of stay of zero days. The data is used to estimate the impact of changes in policy from the Department of Health such as changes to the Payment by Results (PbR) guidance or specialised Information Rules. Similarly, if a provider was to ask for a local tariff modification claiming that they were unfairly penalised under PbR then the benchmarks would be used to see if the data backed this up. Sometimes when discussions are under-way with either an existing or a potential new client, the benchmarks might be used to give an indication of whether a proposed service change would indeed save money or improve services.

PRODUCT 3. Horizon Tool

The main features of the Horizon tool are the saving on the time required in identifying opportunities and providing healthcare professionals with a tool to create informed decisions for their patients.

The Horizon tool condenses vast amounts of data into a simple dashboard that highlights the Clinical Commissioning Groups’ standardised position nationally and against peers. The Horizon tool then provides an indication of the possible Activity and Cost Opportunities if the CCG reached the highest average of their peer CCGs. SUS PbR data is required to benchmark CCGs against their peer CCGs based on similar population, deprivation, age and sex. The Horizon tool then uses the data to highlight potential opportunities for better patient care.

The Horizon tool makes efficient ease of accessing comparable CCG and GP information against the NHS Right Care Conditions. Algorithms applied to the SUS PbR data, at an aggregated level for the Horizon tool will define areas of opportunity for CCG commissioning intentions.

PRODUCT 4. Population Health Management (PHM) Tool

The PHM Strategic Modelling Product applies advanced analytical and actuarial techniques to the data to assess health and care needs and service utilisation within and between population segments. This supports the design of care delivery for specific population segments, so that the allocation of scarce resources amongst service providers can be optimised according to the needs and impactability across their population. It includes predictive analytics to show expected health care utilisation in the future short, medium and long term.

Optum Health Solutions UK Limited works with NHS England on the Integrated Care Systems Population Health Management Development Programme (also known as Module 3 of the Commissioning and Capability Programme). This programme supports systems to improve short-medium term health outcomes for local population cohorts across a 20-week programme through the application of data analysis to intelligence-led care design. The programme enables frontline teams to interpret data to identify the biggest opportunities to achieve improved health outcomes for identified population segments. It supports the clinical and analytical participants in the programme to spread and sustain this learning across their system by training them on applying the analytical techniques that are embedded in the PHM Strategic Modelling Product and interpreting the results to support care design for their population.

Optum Health Solutions UK Limited requires SUS PbR data on a monthly basis, where on renewal of each 1 year term Data Sharing Agreement with NHS Digital Optum Health Solutions UK Limited will destroy the oldest year so that only four years of data is retained at any one time. The benefit to Optum Health Solutions UK Limited’s customers of having monthly SUS PbR data within its products is that the data will remain up-to-date for them so that decisions are based on the latest available data and the data will include tariffs calculated by NHS Digital that will match local SUS data, thus providing consistency and like-for-like comparisons. Benchmarking against the latest year of data ensures customers can see where they are outliers compared to similar organisations and have the time to address issues before they can escalate and grow. The tariffs in the SUS PbR data will enable Optum Health Solutions UK Limited and customers to benchmark against costs/spend with the assurance that the tariffs have been accurately calculated by NHS Digital. The monthly SUS PbR data will allow Optum Health Solutions UK Limited to provide information that is far more actionable than yearly national data. Monthly data allows Optum Health Solutions UK Limited to align analysis to the latest data potentially available to clients comparing latest provider performance against like for like periods, and providing the most accurate timely analysis and comparisons between providers/geographies.

The number of years of data is requested as four years of data with a new month added each month to give sufficient data for trending. Optum Health Solutions UK Limited will destroy the oldest year on each successful renewal with NHS Digital so that Optum Health Solutions UK Limited have four years of data in order to maintain a rolling 4 year dataset. Having 4 years of data is the minimum required to effectively forecast activity and spend in the future. The four years allows Optum Health Solutions UK Limited to effectively factor in seasonal and disease-cycle variation.

The data will be used by NHS organisations, and non-NHS organisations working with STPs and ICSs.

The data requested is necessary for the purposes of the legitimate interests pursued by the controller or by a third party except where such interests are overridden by the interests of fundamental rights and freedoms of the data subject which require protection of personal data, in particular where the data subject is a child (covered by Article 6 (1)(f) of GDPR). The applicant has confirmed that they have a legitimate interest as Optum Health Solutions UK Limited use the information to generate business intelligence information to assist in provision of better patient care.

Processing is necessary for achieving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject – in line with Article 9 (2)(j) of GDPR.

Optum Health Solutions UK Limited will store the data on servers located in N3 connected data centres in Hounslow and London Docklands, England [premises rented from SunGard Availability Services Ltd]. SunGard will have no access to the data or servers, but provide a hosting service via N3 for Optum Health Solutions UK Limited’s servers - the infrastructure is owned by Optum Health Solutions UK Limited but the premises and network connections to the N3 are rented from SunGuard Availability Services Ltd. Sungard also host the virtual server. Optum Health Solutions UK Limited staff in England/Wales will remotely access the server via dedicated Virtual Private Network (VPN) using two or three factor authentication as specified in Optum Health Solutions UK Limited’s Logical Connection Architecture (LCA) agreement with NHS Digital. Access is on a strictly limited basis. The server is only accessible by a limited number of Optum Health Solutions UK Limited staff.

The monthly SUS PbR data will also be loaded into BDPaaS. BDPaas is Optum Health Solutions UK Limited’s big data platform. SUS PbR data will be logically separated from other data not used for analytics on the platform and access strictly controlled via Role based access control (RBAC). RBAC is a way to restrict access based on the individual user role. RBAC gives users access rights only to the information they are allowed to see.

Optum Health Solutions UK Limited analysts complete annual training on handling sensitive records.

Data will only be accessed by Optum Health Solutions UK Limited staff in England who have authorisation to access the data for the purpose(s) described, all of whom are substantive employees of Optum Health Solutions UK Limited. The data is not accessible to Optum Health Solutions UK Limited staff outside of England. Authorisation to access the data is granted through a request process by Optum Health Solutions UK Limited’s Caldicott Guardian and Senior Information Risk Owner (SIRO).

Optum Health Solutions UK Limited analysts will load SUS data into a SQL server, which is dedicated solely for the processing of national SUS data. There are no other data sets stored on the server other than lookups for codes. Within SQL server, stored procedures have been developed to calculate or look up various fields in an automated way (for example Healthcare Resource Groups, specialised service types and costs). After that the relevant counts are taken and proportions calculated, the historic SUS data is used to calculate a probability of admission for various conditions / interventions. In addition, similar proportions or percentages are used to spot coding anomalies or unusual intervention rates in different providers, much as the Atlas of Healthcare Variation does. These aggregated results are transferred to the production servers and fed into various models, predominantly in Excel although other statistical software is also used.

The data required for benchmarking within the Horizon and PHM products require all datasets to be present. Both CCA and HPM use the minimum required datasets to validate data for analytical, benchmarking and commissioning purposes. These datasets have been restricted to just SUS PbR Accident and Emergency, Outpatients, Spells and Episodes datasets only. Our product range uses a minimum of 4 years of historic data to determine patterns of activity and to model future demand.

The monthly SUS PbR data will also be loaded into the Health Population Manager (HPM), Horizon and PHM Actuarial systems and aggregated by the system to GP Practice level for benchmarking purposes. None of the clients have access to the raw patient-level SUS data. The HPM tool has a graphical user interface that is available to NHS clients via a N3 URL. Access is governed by secure role and task based access control, with users requiring a username and password to log in to the system. The user is able to select a "norm" (benchmark organisation) to benchmark their organisation against. Norms are available at GP Practice, locality and CCG level. The users have no access to the underlying patient-level data. No record level data therefore ever leaves the server.

All processing is done on Optum Health Solutions UK Limited infrastructure, at the SunGuard Availability Services Ltd data centres. The LCA agreement between Optum Health Solutions UK Limited and NHS Digital specifies the controls on the Optum Health Solutions UK Limited data centre infrastructure. The data will not be linked with any record level data. Re-identification of individuals is not permitted under this agreement. The data will not be made available to any third parties other than our NHS Clients (as previously specified). Optum Health Solutions UK Limited will not allow the data to be made available to any third parties except in the form of aggregated outputs with small numbers suppressed in line with the HES Analysis Guide.

Optum Health Solutions UK Limited have a number of Clinical Commissioning Groups (CCG) clients spread across England and benchmark against their NHS RightCare peers, which are typically CCGs in another part of the country. The NHS RightCare peers for a CCG are the 10 most similar CCGs in the country as determined by NHS RightCare. The Optum Health Solutions UK Limited team also benchmark against national numbers and other breakdowns from a national level, such as quartiles and deciles. The national data gives the flexibility to benchmark in all these different ways.

Optum Health Solutions UK Limited benchmark high-level utilisation such as total elective admissions and total non-elective admissions. The analysis does not have a specific set of conditions that are used for benchmarking purposes. The conditions used are dependent on the client and the issues that they have in their area. This is often dictated by the initial analysis that NHS RightCare provide, which provides an indication of the patient pathways that could be improved. NHS RightCare is a proven approach that delivers better patient outcomes and frees up funds for further innovation. It gives CCGs and local health economies practical support in gathering data, evidence and tools to help them improve the way care is delivered for their patients and populations.

All organisations party to this agreement must comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data).

The data will only be used for the purposes described in this agreement. The tools mentioned within this application will only be used in England and Wales.

Any reports or analysis of findings provided to Optum Health Solutions UK Limited's customers via the tools mentioned will only include data at an aggregated level, for example, proportion of hernia day case admissions as a proportion of all admissions, with small numbers suppressed in line with the HES analysis Guide. No record level data ever leaves the server and is only used for the tool development purposes listed above.

PRODUCT 1 - the population health analytics tool Health Population Manager (HPM),

The outputs from processing SUS PbR data include;

• A cost and utilisation tracking tool to support targeted opportunity assessment, operational decision-making and evaluation, supported by geo-spatial mapping.

• Use of charts to demonstrate year on year service change and utilisation trends

• Heat maps to highlight areas for greater prevalence of specific diseases

• Functionality to drill into specific areas of concern to establish patterns of patients using Provider, GP practice, CCG and patient demographic information such as age, sex and gender.

PRODUCT 2 - the Commissioning & Contracting suite (CCA),

The outputs from processing SUS PbR data include;

• Allow comparisons between the client’s organisation or population and others nationally for a range of performance metrics such as lengths of stay, emergency admissions, A&E attendance, etc. These National comparators are used by NHS organisations to improve the quality of care delivered by comparing their performance as set out by a specific range of care quality and performance measures, detailed activity and cost reports. The comparators are also used in service redesign and Health Needs Assessment (identifying underlying disease prevalence within the local population compared with the national picture). A customer typically looks at areas of activity that they are outliers for and use these as a way of prioritising service redesign activity and to target areas of deeper analysis and service improvement using more detailed data sources.

• Outputs from CCA are consumed by downstream reporting and products HPM, Horizon and PHA

PRODUCT 3 - the Horizon tool

The outputs from processing SUS PbR data include;

• Easy-to-use dashboards, allowing users to quickly identify savings and quality improvement opportunities

• Calculation of possible financial and better care opportunities from CCG to GP Practices

• Monthly updates of SUS PbR data visible in the front end to CCG users

• Easy to use, intuitive interface, designed to be used by commissioners, as well as healthcare professionals

PRODUCT 4 – Population Health Management (PHM) Strategic Modelling Product

The outputs from processing SUS PbR data include;

• Production of reports that identify the opportunities to achieve improved health outcomes for identified population segments

• Production of reports that identify gaps in care, or unmet need, which can be addressed at scale to reduce utilisation and improve experience & outcomes

• Production of reports that highlight specific bio-psycho-social risk drivers for specific population segments, which can be addressed to reduce utilisation and improve experience & outcomes

• The production of segmentation approaches which can be used for actuarial projections, for planning purposes (both financial planning and operational planning) and to help address excess spend, unwarranted events, gaps in care, and poor outcomes or experience

When reports are provided to clients, data is only included at an aggregated level, for example, proportion of hernia daycase admissions as a proportion of all admissions. Small numbers are suppressed in line with the HES analysis Guide. No record level data ever leaves the server and is only used for the purposes listed above.

Optum Health Solutions UK Limited has used the SUS PbR data in CCA for sense checking data received from a number of clients since early 2016 (verifying that the local data looks accurate in terms of total admissions/attendances) and for benchmarking purposes. For example, Optum Health Solutions UK Limited supported the Bedfordshire, Luton and Milton Keynes (BLMK) Sustainability and Transformation Partnership (STP) group in understanding the total cost of care across the region today and in the future.

The outputs derived from SUS PbR data allow comparisons between the client’s organisation or population and others nationally for a range of performance metrics such as lengths of stay, emergency admissions, A&E attendance, etc. These National comparators are used by NHS organisations to improve the quality of care delivered by comparing their performance as set out by a specific range of care quality and performance measures, detailed activity and cost reports. The comparators are also used in service redesign and Health Needs Assessment (identifying underlying disease prevalence within the local population compared with the national picture). A customer typically looks at areas of activity that they are outliers for and use these as a way of prioritising service redesign activity and to target areas of deeper analysis and service improvement using more detailed data sources.

PRODUCT 1 - the population health analytics tool Health Population Manager (HPM),

Optum Health Solutions UK Limited's HPM provides a software solution using powerful analytics and SUS PbR data to identify opportunities for improving population health and managing costs. Optum Health Solutions UK Limited's HPM provides analytics and insights for early identification of risk within a population, informing decision-making about health investments and allowing the monitoring of cost and utilisation. Using easy-to-use drill-down capabilities to identify key drivers, HPM offers CCGs easy-to-understand benchmark comparisons, using SUS PBR data to create national or locally defined benchmarks to ensure they are focused on the right areas.

The benefits from processing SUS PbR data include;

• Monitoring of cost and utilisation with easy-to-use drill-down to identify key drivers.

• Offers CCGs easy-to-understand benchmark comparisons to ensure they are focused on the right areas of patient and financial outcomes.

• Provides dashboards for the monitoring of NHS saving schemes (eg, Quality, Innovation, Productivity and Prevention (QIPP), etc.)

• Provides dashboards for the monitoring of outcome measures to support outcomes based commissioning.

• Can be used to monitor care management programmes as part of population health models.

PRODUCT 2 - the Commissioning & Contracting suite (CCA),

CCGs are seeking assistance in driving efficiencies and savings from contracts with their main healthcare providers, in order to focus attention on system wide strategic transformation programmes.

The following high level activities will be investigated and will form Optum Health Solutions UK Limited’s approach to delivering a short programme, based on equivalent practices elsewhere in the country.

1. Contract Management Support and review

2. Challenge review

3. Data diagnostics and audit review

4. High Cost Drug review

In order to provide the commissioner and provider of care with the results of the above Optum Health Solutions UK Limited require record level PbR datasets. This is required not only for the analysis but also importantly will form part of the communication between commissioner, provider and a source of data to downstream reporting products.

The benefits from processing SUS PbR data include;

• Applying necessary logic to SUS PbR data to allow for meaningful analysis for downstream products and reports.

• Benchmarking capability to spot outliers for the provision of care.

• Benchmark proposed service changes that affect patient care and commissioner financial savings.

PRODUCT 3 - the Horizon tool

Optum Health Solutions UK Limited will use data to develop NHS RightCare reports and other benchmarking reports for the CCGs Optum Health Solutions UK Limited support in Lincolnshire, Kent and Milton Keynes. Optum Health Solutions UK Limited will also look to provide its tools to CCGs and Integrated Care Systems (ICSs) outside of its current client base. The data will allow Optum Health Solutions UK Limited to provide benchmarking functionality that will identify to CCGs where they are outliers and allow them to investigate further to develop QIPP schemes. Optum Health Solutions UK Limited will also use the data to identify where provider casemix is inconsistent to support contracting discussions.

Optum Health Solutions UK Limited will use SUS PbR data to populate data within the Horizon tool in order to provide CCGs with insight so that they can make better commissioning decisions and to support potential in year and future year savings targets. As an example Optum Health Solutions UK Limited will benchmark activity and derive potential savings for drug usage for Diabetes. Also look to provide an indication of better patient outcomes across England for Cardiovascular Disease and Musculoskeletal conditions. Optum Health Solutions UK Limited will look to provide further evidence required to support national workstreams highlighted by NHS England’s RightCare team.

The benefits from processing SUS PbR data include;

• Enables data-driven approach to saving identification and QIPP planning.

• Utilises national and local intelligence to generate new insights and innovation.

• Easy-to-use dashboards, allowing users to quickly identify savings and quality improvement opportunities.

• Supports and expedites NHS RightCare implementation, aligned to national priority initiatives.

• Fosters transparency and engagement across CCG finance, contracting, commissioning of patient care provision and related delivery teams.

PRODUCT 4 - the Population Health Management (PHM) Strategic Modelling Product.

Optum Health Solutions UK Limited’s PHM product aim to support the NHS Long Term plan by aiding the development of an integrated care system that supports not only current year but the next 5 year operating and financial plans. Taking a population health management approach to target a specific patient cohort. Optum Health Solutions UK Limited’s support to work with and coach the local delivery team to agree and then implement one or more interventions.

The PHM product helps to improves population health by data driven planning and delivery of care to achieve maximum impact. It includes segmentation, stratification and impactability modelling to identify local ‘at risk’ cohorts - and, in turn, designing and targeting interventions to prevent ill-health and to improve care and support for people with ongoing health conditions and reducing unwarranted variations in outcomes. The PHM actuarial module will utilize the SUS PbR data to allow service utilisation comparisons for clients with other population segments.

The benefits from processing SUS PbR data include;

• Assess health and care needs and service utilisation within and between population segments.

• Predictive analytics to show expected health care utilisation in the future short, medium and long term.

• Identify the biggest opportunities to achieve improved health outcomes for identified population segments.

• Use of SUS PbR data to support the interpretation of the results to support care design for their population.

Please see the below case studies from Thames Valley & Wessex on the CCA tool.

For Thames Valley & Wessex CCG clients, Optum Health Solutions UK Limited undertook a benchmarking analysis exercise using the national data to identify pathways where improvements could be made to improve outcomes, spend and patient care. One of the pathways identified was Coronary Heart Bypass Graft (CABG) procedures at a specific hospital. The data indicated that the length of stay for patients in critical care following the procedure was higher at the hospital than other providers.

Optum Health Solutions UK Limited mapped out the patient pathway at the hospital and then compared with evidence based best practice to measure the gap in provider performance. This revealed that the average number of bed days in the Intensive Therapy Unit (ITU) and the High Dependency Unit (HDU) at the hospital were 1.8 days for each, compared with the best practice of 1 day according to Milliman guidelines. Further analysis also identified that not all patients were having a pre-operative assessment, with best practice indicating that this would reduce the length of stay in hospital. Optum Health Solutions UK Limited also found that not all patients were having a routine follow-up appointment at the hospital and some patients were having a follow-up at home with a homecare nursing service.

On behalf of the CCGs, Optum Health Solutions UK Limited negotiated with the hospital and agreed a change in the CABG pathway to:

• Reduce critical care bed days from 1.8 to 1;

• Decommission the homecare nursing service;

• Commission outpatient first and follow-up attendances with surgeon/physician for pre-operative assessments.

This resulted in a better experience for patients in line with best practice and a reduced cost for the CCGs. Overall, £223,072 was identified as potential health economy savings and £150,000 implemented within the contract with the hospital .

The outputs of the benchmarking analysis was also used to help the BLMK STP bridge its financial funding gap. Optum Health Solutions UK Limited supported the STP in calculating its total cost of care and projected financial funding gap. Using the national data, Optum Health Solutions UK Limited benchmarked BLMK against other regions in England to identify opportunities for savings and better care. The benchmarking analysis was used to identify Quality, Innovation, Productivity and Prevention (QIPP) and Cost Improvement Plans (CIP) savings initiatives.

Optum Health Solutions UK Limited is using the national SUS PbR data in a similar way for other clients, including Lincolnshire STP. This would include the use of NHS RightCare methodology to identify savings initiatives for Optum Health Solutions UK Limited’s clients to inform QIPP and CIP schemes.

Customers will receive reports via Optum Health Solutions UK Limited tools based on the national SUS PbR data. The data will remain up-to-date for them so that decisions are based on the latest available data and the data Tools will include the latest tariffs that will match local SUS data, thus providing consistency and like-for-like comparisons.