The NHS Five Year Forward View sets out a vision for the future of the NHS to 2020 and beyond, with implications for all organisations involved in the delivery of health and care services and for the people that use them. Central to this vision is the requirement for health and care systems to simultaneously deliver against the following aims:
- Improve population health outcomes
- Improve the quality and experience of care for individuals
- Maintain or reduce per capita care costs.
Accountable care models are one solution to support delivery and improvement against these challenging requirements. Evidence from Spain, Germany and the USA as well as recent work in England by some of the new model of care Vanguards supports the introduction of accountable models of care. The Vanguard sites and also earlier Pioneer sites working on integrated accountable care systems are being led by a range of health and care organisations, providers as well as commissioners. Such models of care, that may be organised as accountable care systems, partnerships, organisations and others, can support these system aims through a commitment and approach to care planning and delivery which includes:
- Shared system outcomes, accountability and risk; through shared decision making and shared governance structures
- Improved population profiling, care planning and co-ordination across care organisations
- Benefits realisation from the inter-dependencies and opportunities that exist between health and care system stakeholders, for example through economies of scale and reduced duplication of function
- Creating an outcomes-based care approach that shifts focus to affecting the wider determinants of health
- Supporting innovation, patient empowerment and the adoption of evidence-based interventions that improve health outcomes
- Facilitating collaboration within and across care systems to respond to enduring challenges related to an ageing population, increased multi-morbidity and disease chronicity, and public expectation of care.
Developing accountable care models
For local health and care economies, moving from vision to reality in implementing accountable care models will require a phased approach that starts with aligning system vision, strategy and outcomes and on building strong relationships within health and care systems. We believe that developing this system alignment is essential prior to making organisational changes to provision – otherwise there is a risk of putting form before function; ending up with a solution that does not match local population needs; and spending long periods of time focusing on internal structures that fail to achieve tangible changes to the way in which care is delivered for the benefit of the population.
For example, in our experience of developing accountable care approaches, tangible intermediate milestones may be represented first through the definition of a shared system vision and accountable health and social care governance for decision-making, moving then to define a clear outcomes framework, that supports joint working and integrated provider interventions, prior to development of more structured multispecialty community provider (MCP)/primary and acute care systems (PACS) models that may result in organisational changes and ultimately evolve towards accountable care organisations.
How to make it happen – key considerations
Equally, it will be important that commissioners and providers alike recognise the key enablers of change that will support the transition to new models of accountable care and provide the foundations for system sustainability. These enablers will likely include:
- Agreeing proposed governance structures and ensuring that these are deliverable
- Early and sustained engagement with patients, citizens and staff in order to ensure that the accountable care model of care delivers real and necessary change, for the right reasons
- Understanding the benefits to be achieved and how they will be realised
- Understanding the real ‘distance to travel’ to achieve an accountable care model so that realistic plans can be implemented and identified gaps closed
- An evidence-based needs analysis, that recognises the wider determinants of health outside healthcare
- Aligning commercial procurement and contracting strategies to ensure that the scope of services identified to be within the accountable care model of care is achieved
- A clear performance and analytics system with measured and incentivised outcomes
- An integrated shared care record
- A well-defined supply chain
- A clear commissioning approach based on a capitated payment model
- A robust approach to recognising and addressing challenges relating to choice, competition and collaboration within accountable care models
Benefits realisation – agree how the ACO will deliver a step change
In developing accountable care models, local economies will need to assess the best approach to achieve their defined outcomes which may include the future formation of contractual or corporate collaborations. Commissioners, working pro-actively with providers locally, can begin to support the transition to new models of accountable care throughout the commissioning cycle: such as pro-active engagement with partners and providers, including providing early facilitation via their annual commissioning intentions; and applying contractual incentives that support integrated working and the delivery of key outcomes through subsequent contracting rounds. Increasingly we are seeing providers taking over the leadership of the development of accountable care models, supported by local commissioners. Initially, this can take the form of alliance working, but moving progressively to an integrated accountable care model of care, funded by a capitated budget for a whole population.
How we can provide support
There is a clear recognition that “one size does not fit all” in developing new models of accountable care and addressing the current challenges facing health and care systems. Attain delivers in partnership with customers to design, build and implement new models of accountable care that are ambitious, transformative and, most importantly, responsive to customer needs as they relate locally, regionally and nationally. For example, our work in facilitating system thinking and supporting changes in system governance that act as a step change to new models of accountable care
Our service teams can provide expert support in transitioning to new models of accountable care at scale and pace as well as acting in a delivery partner role once the new model is in place to embed and sustain change for the long-term. Each service can provide hands on support separately as set out below, or more commonly we provide a multi-disciplinary approach and combine our teams to develop new models of accountable care capitalising on our end to end organisational knowledge base:
Strategy – System vision, strategic objectives, scope, stakeholder engagement and governance arrangements
Service Transformation – Current state review, service analysis and benchmarking, defining desired outcomes, service delivery model and programme management support throughout implementation
Commercial – Commercial models, payment models and incentives, collaboration and competition, ongoing supply chain management
Please contact us for further information on the services and solutions we offer.