Making sense of accountable care

Briefing from the King's Fund - making sense of accountable care:

Constraints on NHS funding over the past seven years, combined with rising demand from a growing and ageing population, have put the NHS under enormous pressure. It has been clear for some time that simply working our current hospital-based model of care harder to meet rising demand is not the answer. Rather, the NHS needs to work differently by providing more care in people’s homes and the community and breaking down barriers between services.

Also see the King's Fund briefing: acccountable care explained

Growing innovative models of health, care and support for adults

This briefing from SCIE explains that innovative, often small-scale models of health, social care and support for adults could be scaled up to benefit as many people as possible. It makes a number of recommendations for the Government and national partners

Accountable care organisations

This House of Commons briefing paper looks at the introduction of Accountable Care Organisations (ACO) in the NHS in England, the development of the ACO policy, and comment on its potential impact.

Framework for maximising the use of care homes and use of therapy-led units for patients medically fit for discharge

This best practice framework from NHS England aims to address two models and the implementation approach that needs to be taken by sustainability and transformation partnerships (STPs) and their provider organisations with ensuing threats to patient safety, during the winter months.

Making strategic commissioning work: lessons from home and away

With the move towards accountable care, clinical commissioners are starting to take on a more strategic role. This report from NHS Clinical Commissioners aims to support commissioners in these new functions by outlining best practice from health systems around the world which are developing policy around new care models and place-based systems of care.

Some assembly required: implementing new models of care

The Health Foundation has captured some of the experiences of those working on the vanguard sites of the new care models programme in England.

A two-way street: what can CCGs teach us about accountability in STPs?

This report from the Nuffield Trust explores the accountability and performance management arrangements for CCGs and looks at the implications of these for STPs and accountable care systems. It is based on 13 interviews with senior CCG leaders and NHS England policy makers which took place in September 2016.

New technology, earlier diagnosis and better coordination of care in cancer

“Achieving World-Class Cancer Outcomes – Progress Report 2016-17” describes the significant advances the National Cancer Programme has made over the past year as it moves towards the full delivery of the NHS five-year national cancer strategy. The strategy was developed in 2015 by an Independent Cancer Taskforce that was asked to deliver the vision set out in the NHS Five Year Forward View.

The report describes progress across the field including:

• Modernisation of radiotherapy equipment throughout the country.
• New models of care introduced to ensure cancer is diagnosed earlier and improve survival.
• Establishment of Cancer Alliances across the country to bring together clinical leaders, healthcare workers, patients and charities for better coordination of care.

Enabling providers to develop new care models

Commissioners will play an important role in empowering providers to work together to establish the collaborations that may evolve to become the accountable care systems of the future.  Find out more in these four articles, published by PCC:

• Getting GPs on board remains a big issue for accountable care organisations
• NHS England’s proposed contractual approaches for accountable care models
• Commissioners must drive but leave providers to steer new care models
• Accountable care organisations need support to get GPs’ pay right

The NAPC compares models of accountable care in the UK and the USA

This paper looks at the provision of accountable care. Based on discussions between health leaders from the UK and US at a symposium in May 2017, it compares the delivery of primary care in the UK and USA through Accountable Care Organisations and Accountable Care Systems.

The report describes accountable care as a model that brings together groups of different healthcare providers to serve the needs of a specific population, within a specified budget and with particular outcomes in mind. It suggests that accountable care is “particularly attractive for developed countries at a time when ageing populations and an increase in chronic diseases have led to rising and unsustainable costs in care delivery”. It is seen as a way of moving beyond rhetoric to reality to transform and integrate care.

STPs and accountable care

The programme from NHS Providers aims to ensure there is the right support and a strong advocate making the case for NHS trusts as they move to accountable care structures that deliver more integrated care for the public.

As NHS approaches 70 it is time to unleash the potential of innovation to transform patient care

The head of NHS England, Simon Stevens has set out an ambitious vision for the National Health Service as it approaches its landmark 70th anniversary.

Mr Stevens will unveil new plans to free up funds for the latest world class treatments by slashing hundreds of millions from the nation’s drugs bill and announce that new and cutting edge treatments will be routinely available for the first time.  Innovations include:

• Revolutionary new treatment for Hepatitis C is set to save NHS England more than £50 million as well as saving thousands more lives
• New measures to slash up to another £300 million from the nation’s medicines bill
• Trailblazing new treatment to restore sight using patients’ own teeth
• Routine commissioning of the latest technology to help deaf children hear
• An expansion of the test-bed programme testing the treatments and care models of tomorrow

Accountable care models contract: proposed changes to regulations

The Department of Health is seeking views on changes to the regulations on the running of an NHS standard contract (accountable care models).

The development of the Accountable Care Organisations contract has identified some necessary changes to regulation. This is largely to ensure that current rules continue to apply to the new contract, and the organisations using it.

New report showcases how new care models are harnessing technology

A new report from NHS Confederation, NHS Clinical Commissioners, NHS Providers and the Local Government Association, New care models: harnessing technology, explores how five vanguards are implementing innovative digital technology solutions at the heart of a new approach to care.

Service specification for integrated urgent care

NHS England has published a national service specification for integrated urgent care services. It outlines the steps that commissioners must take to deliver this important transformation and to move from an ‘assess and refer’ to a new ‘consult and complete’ model of service delivery.

Developing accountable care systems: lessons from Canterbury, New Zealand

New article published by the King's Fund

There are clear parallels between pressures the Canterbury health system was facing at the start of its programme of transformation and current pressures on the NHS – including financial deficits, rising demand and declining performance in emergency and elective care. Given the positive impact that the changes in Canterbury have had, it is worth considering the lessons that the NHS can learn as it embarks on its own journey of transformation. 

The interventions and delivery models used in Canterbury offer practical lessons for other health systems, as does its approach to change, which includes a strong emphasis on system working, staff engagement, co-design and continuous quality improvement. Technology has been key to Canterbury’s success, and local investment and innovation have been central to this. Developing solutions in partnership with clinical users has been key to their successful design and uptake.

Revised ACO contract to replace MCP and PACS versions

In July 2016, NHS Improvement published the multispecialty community provider (MCP) emerging care model and contract framework. As well as describing the MCP care model in more detail, it introduced the MCP Contract and business model that underpins it. An initial draft version of the MCP Contract was published in December 2016 for a period of public engagement and informal feedback.

Following this feedback, the Accountable Care Organisation (ACO) Contract and supporting documents have now been revised for use by local commissioners to inform the early stages of their procurement processes. Importantly, the Contract can now be used for accountable care models generally, including MCP and integrated primary and acute care system (PACS) models.

The ACO Contract has been produced following intensive joint work with a number of vanguards with whom we are co-developing the approach to ensure that the Contract is able to help facilitate local plans.

We will be working with commissioners in the most advanced areas to test the revised Contract and to improve it further and plan to release an updated version for formal consultation in 2018.

Accountable care organisations (ACOs) explained

Briefing from the King's Fund about accountable care organisations (ACOs). NHS England has recently outlined ambitions for sustainability and transformation partnerships (STPs) to evolve into ‘accountable care systems’ (ACSs), and proposed that these ACSs might become ACOs but only after ‘several years’. Eight areas of England have now been identified to lead their development. They comprise three core elements.

First, they involve a provider or, more usually, an alliance of providers that collaborate to meet the needs of a defined population. Second, these providers take responsibility for a budget allocated by a commissioner or alliance of commissioners to deliver a range of services to that population. And third, ACOs work under a contract that specifies the outcomes and other objectives they are required to achieve within the given budget, often extending over a number of years.

Intermediate Care

This paper, from SCIE, sets out evidence to guide the growth of intermediate care. It looks at why the development of intermediate care requires fresh impetus, sets out learning points that can guide its development and provides case studies covering reablement and bed-based intermediate care.

Integrating care: contracting for accountable models NHS England

NHS England has published information on contractual arrangements for accountable care organisations.

This package clarifies how accountable models may be contracted for, how local areas would approach procurement questions and the application of the new Integrated Support and Assurance Process, run by NHSE and NHSI in relation to the award of all novel or complex procurements by commissioners. It sets out the funding model including the details of integrated budget approaches, a new Improvement Payment Scheme to replace current incentive schemes and gain/loss sharing across the local health economy to align incentives. Finally, the package describes implications for the commissioning system of new models of whole population provision.