What new care models may mean for accountability and commissioning

Rachael Addicott, Senior Research Fellow r.addicott@kingsfund.org.uk @RachaelAddicott

Looking for new ideas

Accountable Care OrganisationAlliance Contract Prime Contract

All focus on integrated

delivery of care

International experience› High performing integrated systems use capitated budgets for

almost all care

› Main focus is on population based budgets not disease or condition based budgets

› They specify the quality/outcomes they expect to be delivered

› Systems are not over-reliant on payment methods and financial incentives – other tools are also important

Are we all talking about the same thing?

Experience of organising integrated care in England

› Purchaser provider split = contractual solutions

› Population health vs disease/population segment

› Scope and boundaries

› Defining a budget

› Cost shifting and risk shifting

› New competencies

› Supply chain management

› Collective governance and accountability

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

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