Steve How explains how Wilmington Healthcare's unique behavioural methodology is being used to map patient journeys across the integrated care landscape

Integrated care is driving major reconfiguration across NHS patient pathways and this is being accelerated by new joined-up finance models that see providers working together to determine how money should be spent locally.

There are opportunities for pharma to get involved in helping to shape care pathways. However, it is often difficult to show where and why pathway changes are needed, let alone implement them.

At Wilmington Healthcare, we have been using our unique Costed Integrated Patient Scenarios methodology to explore patient pathways across primary and secondary care and determine best practice.

The starting point

The Costed Integrated Patient Scenarios methodology, which can be applied to a wide range of areas from surgical care to the management of people with long-term conditions, identifies the key components of an optimal best practice pathway compared to an existing or suboptimal pathway where care is reactive and unplanned. It takes account of economic, health and social care issues, supported by data analytics to provide a costed analysis comparing optimal and average practice with detailed pathway costs and workforce implications.

The Costed Integrated Patient Scenarios process begins with a literature search on a specific pathway. It is then followed by detailed discussions amongst a multi-disciplinary team of key stakeholders on all aspects of the pathway, from presentation, through to specialist intervention and care management in the community.

The stakeholders will explain how they are currently managing patients and identify any potential bottlenecks within the system to determine where change might be beneficial. A straw man pathway is created involving a fictional patient who is given a name and back story, which brings the process to life.

Gaining consensus

The straw man pathway is debated by the key stakeholder group to determine what is important for that patient, their family and the NHS, thereby creating a comprehensive framework of the patient journey and the obstacles within it.

Once the research and discussions are complete, a Delphi academic process is used to gain consensus on the patient journey and what will need to happen to deliver optimal care. The aim is for an 80% consensus on optimal care and, once achieved, a further review of the Costed Integrated Patient Scenario is undertaken by independent expert reviewers.

As part of the process, Wilmington Healthcare works with charities and patients to better understand patient needs and priorities and identify the wider implications and cost of illness, such as loss of employment and the need to provide care at home.

Once the pathways are agreed each contact, intervention and treatment is costed by our health economics team, to map out comparative costs and workforce implications across each of the organisations involved and the system as a whole. The scenario is then brought to life as a case study by our medical writing team. Personalisation of this costed scenario supports engagement with the whole team involved in managing and transforming care to bring about change for optimal care.

Long-term, joined-up benefits

A Costed Integrated Patient Scenario is developed alongside a suite of collateral that supports and explains the extensive benefits of the analysis. All of this work is conducted independently of pharma sponsors and provides a powerful, evidence-based illustration of the wide-ranging implications of an optimal pathway versus existing or suboptimal care.

Importantly, the study identifies a critical window of opportunity when a specific intervention or course of action can significantly improve patient outcomes and lead to better and more cost-effective care.

The evidence produced via a Costed Integrated Patient Scenario can assist a pharma company in determining whether its products really can help to improve a patient pathway and exactly where and how they could deliver benefits that will improve joined-up patient care and support the NHS’ Long Term Plan goals.

If an opportunity is identified, the patient story can kickstart conversations with commissioners and transformation leads, providers, procurement departments and clinicians; conversations that demonstrate a real understanding of whole system costs and show how changes can be made to improve patient outcomes, save money and help the NHS deliver preventative, population-based care.

Find out more about Costed Integrated Patient Scenarios here.

Steve How is programme director, at Wilmington Healthcare. For information on Wilmington Healthcare, visit