Guidance

Improving Access to Psychological Therapies payment: an introduction

An approach to payment for providers of IAPT services that links payment to patient outcomes as well as the provider’s levels of activity.

What is Improving Access to Psychological Therapies payment?

The Improving Access to Psychological Therapies (IAPT) programme for adults (over 18), launched in 2008, aims to make evidence-based psychological therapies for depression and anxiety disorder more widely available in the NHS.

Responding to the challenge set by the Five Year Forward View (5YFV), this local payment example describes a local payment approach that commissioners and providers of IAPT services can use that:

  • systematically links payment to patient outcomes
  • takes proper account of:
    • case complexity
    • the provider’s levels of activity.

Why payment reform is needed

The 5YFV proposes a fundamental shift in the way that health care is commissioned, with an emphasis on payment approaches that more directly reward quality.

Linking payment to outcomes presents significant opportunities for providing cost-effective early interventions to support people experiencing low level mental health problems, as well as the ability to monitor performance and achievements, and the impact on costs in the system.

Underpinning the IAPT payment example is the assumption that incentivising the delivery of effective, evidence based treatments in a consistent manner will improve clinical recovery rates.

This will also enable a range of clinical and non-clinical benefits such as employment and/or well-being improvements to the individual, their families, local communities and the wider economy.

A payment approach for IAPT services

To support the development of quality and effective IAPT services, this payment approach has been developed to reward providers for delivering outcomes.

Outcomes are measured against areas that matter to people and support their daily activities, including:

  • specific and relevant clinical outcomes
  • access standards
  • user experience
  • choice
  • employment
  • and more holistic measures of wellbeing

By focusing on these measures, this approach supports providers to focus on achieving improved well-being for patients as well as good clinical outcomes.

Commissioners can use these outcome measures to identify and reward the most effective service providers.

The model also gives commissioners the ability to influence provider delivered outcomes by:

  • adjusting the relative level of reward associated with individual performance measures
  • incentivising delivery of the outcomes that matter most locally, for example improving access by older people or ethnic minorities, or readiness for employment.

The IAPT payment approach also recognises the challenge faced by providers delivering good outcomes, for example the complexity of people’s needs or the ease with which good outcomes can be achieved. It therefore includes an element of activity based payment.

The approach also draws upon the following features:

Cluster-based tariffs

Cluster-based tariffs are based on an episode of care and the needs of those people in receipt of it. Patients allocated to higher clusters are significantly more likely to require high intensity treatment. Therefore cluster-based episode prices can be used to incentivise treatment of more severe cases, avoiding perverse incentives to “cherry pick” less complex cases.

Activity payments

A basic service price for each assessment that the service undertakes and a minimum payment for each of the mental health clusters that IAPT services are expected to treat.

Help us refine and improve this approach

Monitor and NHS England will work with commissioners and providers keen to implement this payment approach.

We’ll refine the payment example as we learn more from local health economies that implement these new models.

If you’re exploring the use of this payment approach, we’d like to hear about your experiences. Email us at pricingenquiries@monitor.gov.uk.

More detail on this approach

Our paper Local payment example: Improving Access to Psychological Therapies provides guidance for finance, contracting and commissioning staff on how to approach developing and implementing the potential new payment approach locally

Published 27 July 2015