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The Book

Outcomes Based Commissioning- Healthcare provides a practical, introductory guide on how to plan, commission, measure and achieve improved care and outcomes for people. Due for publication:  2018 with Wiley (UK).

Author: Dr Rupert Dunbar-Rees BSc, MBBS, MBA (Dist), MRCGP

Outcomes based commissioning (OBC) is an emerging field and an increasingly recognized approach in healthcare. This book will help the increasing numbers of people involved in commissioning healthcare to get their ‘head around the subject’ of outcomes based commissioning. It explains first principles and how to actually start commissioning and improving patient outcomes. It will be a practical guide but will also include relevant further reading reference for those wanting to explore specific topics in greater depth.

There are a number of misconceptions about OBC which will be addressed. They include the following examples:

  • ‘Outcomes are hard to define’
  • ‘Outcomes are so multi-factorial that they are hard to interpret’
  • ‘Outcomes take ages to become apparent, and therefore are hard to contract for’
  • ‘Outcomes should only be created for what is currently measurable’
  • ‘Contracting for outcomes should only be for outcomes which are entirely within one Provider’s control’
  • ‘Don’t measure outcomes which are difficult to attribute’

Throughout the course of the book, each of these misconceptions will be dealt with in detail and solutions offered to overcome perceived obstacles. We’ll explore in detail the importance of seeing outcomes through eyes of people receiving care, and the importance of co-production in defining outcomes.

We’ll draw upon international examples and best practice and provide guidance on the more complex and challenging issues such as contracts, payments and IT systems. The concluding chapter will address the future development of OBC with healthcare and further tips on how to commission for outcomes.


  • Why commissioners are moving towards Outcomes Based Commissioning
  • What’s wrong with current, activity and process based commissioning
  • Examples of OBC currently underway
  • Peer reviewed case studies and related cases
  • OBC as a driver of provider collaboration, integration, innovation
  • Can we really afford not to?
  • What OBC is, what it means
  • How OBC fundamentally differs from existing approaches
  • The importance of sequence; defining population segments and outcomes before looking at contracts, IT payment system etc.
  • What it means for healthcare costs and outcomes – how would patients feel the difference in an outcomes based system?
  • Advantages of outcomes approaches – worked examples: e.g. not just purchasing a hip operation, instead paying for the extent and speed of return to physical activities and/or work- however achieved
  • Moving away from activity based commissioning categories (planned care, unscheduled care etc.) towards commissioning for pathways and populations of patients with similar needs
  • ‘How to’ segment commissioning according to similar needs
  • Dealing with co-morbidities, complex care needs, and segmentation complexities
  • Stopping patients ‘falling through the gaps’
  • Understanding some fundamentals – what’s an outcome, what’s not an outcome
  • Whose outcome is it anyway?
  • Strengths and weaknesses of structure, process and outcomes indicators
  • How PREMs and PROMs fit in
  • More challenging areas:
    • defining outcomes frameworks for patient segments
    • co-producing outcomes with patients
    • understanding outcomes hierarchies
  • Innovative/emerging contracting models – to underpin moves towards OBC across multiple providers (e.g. Accountable Lead Provider, Alliance contracts, Federations/Networks)
  • Competition, procurement and tendering issues in commissioning services for outcomes
  • How to support competition over outcomes using different contractual models
  • Understanding the difference between price and cost, and why it’s important
  • How costing is done now, and how it needs to change
  • Latest developments in bundled pricing/reimbursement for OBC
  • Whole patient pathway payment examples (including international pilots)
  • Payment across multiple providers
  • How enabling IT systems underpin development of outcomes based approaches
  • Data collection for outcomes-
  • Dealing with ‘messy data’
  • Dynamic PROMs and PREMs
  • What this means for patients and providers
  • Use of facilitated social networks to supporting outcomes based commissioning
  • How the provider market could evolve in response to the OBC stimulus with examples (e.g. Provider re-configuration – Integrated Practice Units now emerging: e.g. in Acute care – Department of joint pain, rather than current organizational divisions – Orthopaedics, Rheumatology etc.)
  • Ten things to do next if you want to commission for outcomes