There are a number of steps that were followed in designing the AMHCC:
- Definition of services
- Identification of cost drivers
- Patient level costing study
- Development of the classification system and associated infrastructure (data set specifications, grouping software, etc)
- Ongoing activity and cost data collection
Definition of services
In 2012, IHPA engaged a consortium led by the University of Queensland (UQ) to develop a definition of mental health care for ABF purposes and to define the cost drivers associated with these services.
Part A of the UQ report proposed the creation of a separate care type for mental health services and an associated draft definition for classification purposes.
The care type definition proposed by UQ was modified slightly and endorsed by the Mental Health Working Group (MHWG) on 21 March 2013, IHPA’s Jurisdictional Advisory Committee (JAC) on 8 May 2013 and approved by the Pricing Authority on 31 May 2013.
The care type definition approved by the Pricing Authority is:
Mental health care is care in which the primary clinical purpose or treatment goal is improvement in the symptoms and/or psychosocial, environmental and physical function relating to a patient’s mental disorder.
Mental health care:
- is delivered under the management of, or regularly informed by, a clinician with specialised expertise in mental health;
- is evidenced by an individualised formal mental health assessment and the implementation of a documented mental health plan; and
- may include significant psychosocial components including family and carer support.
Note that "assessment only" activities are considered in scope for the classification.
Part B of the UQ report identified possible cost drivers for further examination in the classification development. The UQ work involved a number of phases including:
- Comprehensive literature review;
- Wide ranging stakeholder consultation; and
- Quantitative analysis using data obtained from Queensland, Victoria and New South Wales.
The results of the quantitative analysis are consistent with the literature and confirm that mental health costs are driven by multiple factors, including (but not limited to) complications and comorbidities, symptom severity and function as well as some contribution from patient diagnosis as a lesser contributing factor.
Part B of the UQ report also considered options for a classification architecture. The proposed architecture broke a patient episode of care into mental health phases.
A key finding of the UQ report was that the costing data submitted to the National Hospital Cost Data Collection (NHCDC) by jurisdictions for mental health services “was patchy at best”. UQ proposed that IHPA commission a one-off study or series of one-off studies to develop the mental health classification.
In February 2014, IHPA engaged a HealthConsult-led consortium to undertake a six month costing study in 26 hospitals across Australia including both public and private hospitals, and community mental health services.
The Mental Health Costing Study commenced at study sites on 1 July 2014. Data collection was completed in December 2014. Data collected from the study has informed the development of the AMHCC.
The final report for the Mental Health Costing Study was released in February 2016.
Development of the classification system and associated infrastructure (data set specifications, grouping software, etc)
IHPA developed the AMHCC based on data obtained from the Mental Health Costing Study, clinical advice and an expert reference group of mental health care and data specialists. Additionally feedback received through two public consultation processes, a pilot conducted at four sites nationally, and members of the Mental Health Working Group were incorporated into the draft AMHCC in preparation for the release of Version 1.0 of the AMHCC from 1 July 2016.
The following materials are required to support implementation of AMHCC Version 1.0:
- the Activity Based Funding Mental Health Care Data Request Specification (ABF MHC DRS) and Data Set Specification (ABF MHC DSS) which specify the activity data items required for collection.
- incorporation of phase of care into the National Hospital Cost Data Collection (NHCDC) Data Request Specification for Round 20 (2015-16)
- the AMHCC User Manual and Mental Health Phase of Care Guide;
- an AMHCC grouper and accompanying specification guide which assigns mental health consumer presentations to the appropriate AMHCC end (to be released in late July 2016)
The development and refinement of the AMHCC will be an iterative process. There will be ongoing activity and cost data collection which will support the ongoing refinement of the AMHCC and pricing of mental health care services in the future.