An evidence-informed framework for high-value program procurement by Primary Health Networks

Models of commissioning health and social services have been implemented across Australia and internationally. Thirty-one Primary Health Networks (PHNs) across Australia have responsibility for the commissioning of services across a geographical catchment, involving a phased process of needs assessment and insight; planning and delivery; and monitoring and evaluation. Professor Jon Karnon, Professor Gill Harvey, Professor Suzanne Robinson, Jade Hart and Kenneth Lo explore the considerations for what evidence-informed procurement means in practice, and current efforts underway to develop a framework to optimise high-value program procurement.

A summary of this research will be presented at a symposium at the Primary Health Care Research Conference, to be held at the Pullman Melbourne on the Park from 1-3 August 2018.

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Thirty-one Primary Health Networks (PHNs) across Australia have a role in commissioning of services for a defined geographical area and associated communities. The PHN Programme is an Australian Government initiative which seeks to i) increase the efficiency and effectiveness of medical services, particularly those at risk of poor health outcomes; and ii) improve coordination of care to ensure patients receive the right care in the right place at the right time.

To achieve these objectives:

“[PHNs will understand] “the health needs of their PHN communities through analysis and annual planning. They will know what services are available and help to identify and address service gaps where needed, including in rural and remote areas, while getting value for money.””

— Source: Commonwealth Department of Health, PHN Grant Programme Guidelines, 2017 [1]

Translating objectives into commissioning and procurement practice

PHN commissioning follows a systematic approach to planning, procurement and monitoring and evaluation (refer Figure 1). The commissioning cycle stages and milestones support a rigour of approach consistent with contemporary expectations of legitimacy, accountability, and transparency in relation to public investment decision-making in health and social care. However, the relative simplicity that Figure 1 conveys must be interpreted within the context of the scope of the two PHN objectives. A deeper and value-laden understanding of commissioning acknowledges that it is not merely a process but a more holistic, strategic, and population-health focused whole-of-organisational approach which maximises the usage of available levers. Commissioning and procurement efforts must reflect legacy arrangements, the current environment, and be future state-oriented.

Figure 1: PHN commissioning cycle

Source: Commonwealth Department of Health, Designing and Contracting Service Guidance, 2016 [2]

The role of research evidence

It is within this context that research evidence must frame the collective understanding of ‘what works, where and under what circumstances’. Primary care interventions can be complex and involve multiple components. The success of an intervention depends on various factors such as having health program components which are effective in the local context, commitment and acceptance by various stakeholders and communities, and availability of local resources/capacity to implement and maintain the program. The traditional systematic review approach of utilising quantitative outcome data for statistical meta-analysis may not be sufficiently comprehensive to incorporate the multi-faceted considerations of a complex primary care health program. Researchers and practitioners have endeavored to resolve the way research evidence, people, processes and systems interact to facilitate evidence-informed procurement of primary care services.

Stakeholder and service provider engagement are key aspects of commissioning and procurement that seek to ensure that local needs and capability are understood and that research evidence-based interventions can be feasibly implemented. Relevant research evidence may be qualitative (e.g., investigating barriers and facilitators to the specified objectives) or quantitative (e.g., statistical comparative studies of the effects of alternative service options). Ultimately, there are many options for using available evidence, which may vary from procurement process to procurement process, and depend on the specified objectives, the available research evidence, and the views of the local stakeholders. Yet how options are appraised must be consistent with pursuits toward legitimacy, accountability, and transparency. Opportunities exist to formalise and strengthen the manner in which research evidence is co-transformed with stakeholders for use in commissioning and procurement.

Towards an evidence-informed framework for high-value program procurement

We propose developing a framework that seeks to support PHNs to prioritise and make sound investment decisions by incorporating research evidence and the multi-faceted considerations of stakeholders/users, context and resources. Frameworks of these sort have been longstanding in other sectors (e.g. the funding of new pharmaceuticals and medical services are governed by the Pharmaceutical Benefits Advisory Committee and Medical Services Advisory Committee respectively), albeit within the context of different interventions and evidence bases. The framework would seek to provide a structure to combine academic rigour and practical relevance to reflect the complexity of primary health care interventions, contextual features, and local decision-making. Consultation and pilot testing of a framework with PHNs across Australia which incorporates evidence review and the co-creation of a research evidence summary report is underway. The emphasis on co-creation seeks to provide a basis to bridge the “research to practice” divide, provide structures for building shared understanding, and provide insight into options and an optimal way 

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About the Authors:

Jon Karnon is a Professor of Health Economics. He has been undertaking economic evaluations of health care technologies and services for over 20 years, including ongoing work with the SA PHNs to build economic evaluation into the PHN procurement process.

Gill Harvey is a Professorial Research Fellow at Adelaide Nursing School. Her research is focused on knowledge translation and facilitating the implementation of evidence in health care practice and policy. She has a particular interest in realist approaches to primary and secondary research.

Suzanne Robinson is Professor of Health Systems and Health Economics. She leads international research on decision making and priority setting and disinvestment in health, this work involves a number of aspects, in particular the use of health data sets to produce an evidence base to inform resource allocation decisions.

Jade Hart manages the Victorian Primary Health Network Alliance which seeks to optimise the collective capabilities of PHNs, align efforts with a statewide purview, and advance primary care reform. Jade is also a University of Melbourne PhD Candidate where her research interests examine evidence use, decision-making, and health system stewardship.

Kenneth Lo is a Research Fellow at the Australian Institute of Health Innovation at Macquarie University. His research focuses on the application and development of evidence review methodologies for the evaluation of effectiveness and economic cost outcomes.

Research team contact: jonathan.karnon@adelaide.edu.au

Victorian PHN Alliance contact: jade.hart@vphna.org.au

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References

1. Commonwealth Department of Health, 2017, PHN Grant Programme Guidelines, available http://www.health.gov.au/internet/main/publishing.nsf/content/PHN-Program_Guidelines. Accessed 10 July 2018.
2. Commonwealth Department of Health, 2016, Designing and Contracting Service Guidance, available http://www.health.gov.au/internet/main/publishing.nsf/Content/E11D6513E6583EA1CA2580D4000F0A70/$File/PHN%20Designing%20and%20Contracting%20Services%20v0.1.pdf . Accessed 10 July 2018.