The Organisation of Integrated CareRachael Addicott, Senior Research Fellow

r.addicott@kingsfund.org.uk

@RachaelAddicott

Why?

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

How?

› 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

Are we all talking about the same thing?

…or a progression?

So, what is an ACO?

› 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?

Four things to remember…

› Engagement with providers, patients and wider communities

› Importance of both transactional and relational approaches

› Alignment of payment mechanisms and incentives

› Focus on building governance structures and processes