the nhs five year plan-rachael addicott presentation
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The Organisation of Integrated CareRachael Addicott, Senior Research Fellow
r.addicott@kingsfund.org.uk
@RachaelAddicott
Context for change
› Quality improvement and cost containment
› Failures where patients fall through the gaps
› Limitations to informal collaboration
› Barriers to care coordination / disease management
› Fragmented payment system
› Information systems
› Primary and Acute Care Systems (PACS) would provide list-based GP and hospital services, together with mental health and community care, in single NHS organisations
› Could take accountability for the whole health needs of a registered list of patients, under a delegated capitated budget
› Similar to Accountable Care Organisation model
› Group of providers that accept accountability for the cost and quality of care provided to a defined population of potential patients
› Coordination of care across a network of providers
› Interdependency: cost savings more likely if partners work together
› Defined patient population
› Care management and predictive risk modelling
› Shared governance structure (ie. ACO Board)
› Shared accountability for quality and cost of care
› Shared risk and savings: on condition of meeting quality metrics
Collective accountability
› Reliance on informal influence
› Appeals to professional competitiveness
› Credibility of data
› Development and coaching – “learning opportunity”
› Financial penalties
› Removal from ACO network
soft
hard
Experience of organising integrated care in England
› Who’s accountable for integration?
› Purchaser provider split = contractual solutions
› Baby steps leading to problems in scope and boundaries
› Cost shifting and risk shifting
› New competencies – eg. supply chain management
› Defining a budget
› Choice and competition?
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