Casemix Capacity Development: Phases 2 and 3
Silver Chain Health
Duration: April 2017 – September 2018
A research partnership was established with the Silver Chain Group in 2016 when Phase 1 of the casemix capacity development program was completed. The project had been commissioned in response to changes in the community-based care sector where there were evolving external demands and increased competitiveness in pricing and service, and there was recognition within the organisation that a casemix based approach to management would support sustainability of service maintenance. The Phase 1 study established that Silver Chain’s data collections and information management systems could support such an approach. Phases 2 and 3 of the program were commissioned to continue the development program for Silver Chain Health.
Two streams of work run in parallel in Phase 2, with one stream addressing the technical information system priorities identified in the Phase 1 gap analysis, and the other incorporating a casemix based costing study and the development of a casemix based classification system. Phase 3 involves systems refinement and planning for the longer term priority issues and building the capacity for casemix based management within Silver Chain.
What we did
Two issues had been identified in the gap analysis as key dependencies for the project; the provision of a data governance framework and developing a working definition for an episode of care, and these were both addressed early in the Phase 2 activities.
The ‘episode of care’ definition was required to establish a unit of counting that was suitable for costing and classification development. This unit needed to give consideration to meaningful clinical milestones and resource usage, rather than being aligned with service contracts as was currently the case. The definition was developed in consultation with an expert panel from Silver Chain and incorporates both the type of care (the ‘product’) and the ‘goal’ of care. Using a variety of business rules and assumptions the definition was applied retrospectively to a two year data set to organise all client visits into client episodes of care.
The other large piece of work completed was an activity-based costing study on the 2016/17 expenses and activity data. This involved extensive investigation and consultation with key Silver Chain staff to determine the in-scope finances and client activity, cost centre types, cost allocation methodologies, account rollups, costing fractions, and the linking of activity data to expense data. The draft costing results and methodology report was submitted to Silver Chain at the end of 2017.
Preparatory work for the classification development was also undertaken, with ongoing exploration of the information from the available client information systems, both administrative and clinical; to identify any potential cost drivers that could be tested for incorporation in the classification as splitting variables.
Phase 3 is scheduled for 2018 and will be completed along with the remaining Phase 2 activities.