Accountable care system

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An accountable care system is a system of healthcare provision which is intended to be integrated, and in particular to merge the funding of primary care with that for hospital care, therefore providing incentives to keep people healthy and out of hospital. It has features in common with accountable care organizations in the United States.

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England

Accountable care systems were organisations in the English NHS which in some respects are intended to replicate the features of the American accountable care organization. They were defined by NHS England as an area ‘in which commissioners and providers, in partnership with local authorities, take explicit collective responsibility for resources and population health’. [1] After a great deal of hostility to the use of the term it was announced in February 2018 that these organisations were in future to be called integrated care systems, and that all the 44 sustainability and transformation plans will be expected to progress in this direction. [2]

New Zealand

Canterbury, New Zealand has developed an accountable care system which has been held up as an example in the UK. Canterbury District Health Board has what is regarded as a successful system which has moderated the rate of growth in hospital use by investing in services in the community. [3]

According to the King's Fund there were three key ingredients in the success of this system, which took several years to develop were:

The system has moderated demand for hospital care, particularly among older people, with lower acute medical admission rates compared with other parts of New Zealand and lower acute readmission rates, a shorter average length of stay with lower emergency department attendances, higher spending on community-based services and lower spending on emergency hospital care. However the number of hospital beds has not been reduced and the system struggles to meet demand. [4]

Spain

Alzira, Valencia has a capitation based system with integration between primary and secondary care providers and a unified IT system across all services. This has become known as the Alzira model and received a great deal of attention. Under this model the provider receives a fixed annual sum per local inhabitant (capitation) from the regional government for the duration of the contract, and in return, must offer free, universal access to a range of primary, acute and specialist health services to the local population. It required a unified information system across all the services, with a shared patient record between GPs and specialists. In Alzira patients were free to go elsewhere for care, and if they did so the local provider had to meet the cost.

The quality of services appears to be considerably higher than other health care systems, with more day surgery, lower emergency admission rates, lower re-admission rates and higher patient satisfaction. [5]

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In the healthcare industry, pay for performance (P4P), also known as "value-based purchasing", is a payment model that offers financial incentives to physicians, hospitals, medical groups, and other healthcare providers for meeting certain performance measures. Clinical outcomes, such as longer survival, are difficult to measure, so pay for performance systems usually evaluate process quality and efficiency, such as measuring blood pressure, lowering blood pressure, or counseling patients to stop smoking. This model also penalizes health care providers for poor outcomes, medical errors, or increased costs. Integrated delivery systems where insurers and providers share in the cost are intended to help align incentives for value-based care.

Fee-for-service (FFS) is a payment model where services are unbundled and paid for separately.

<span class="mw-page-title-main">Emergency medical services in the United Kingdom</span> Overview of emergency medical services in the United Kingdom

Emergency medical services in the United Kingdom provide emergency care to people with acute illness or injury and are predominantly provided free at the point of use by the four National Health Services (NHS) of England, Scotland, Wales, and Northern Ireland. Emergency care including ambulance and emergency department treatment is only free to UK residents and a charge may be made to those not entitled to free NHS care.

Healthcare in England is mainly provided by the National Health Service (NHS), a public body that provides healthcare to all permanent residents in England, that is free at the point of use. The body is one of four forming the UK National Health Service as health is a devolved matter, there are differences with the provisions for healthcare elsewhere in the United Kingdom, and in England it is overseen by NHS England. Though the public system dominates healthcare provision in England, private health care and a wide variety of alternative and complementary treatments are available for those willing and able to pay.

Yeovil District Hospital NHS Foundation Trust runs Yeovil District Hospital in Yeovil, Somerset, England. It provides acute care for a population of about 180,000, people living in South Somerset, North and West Dorset, and parts of Mendip. The hospital admits around 30,000 inpatients or day cases each year and treats more than 90,000 people in the outpatient appointments. Approximately 40,000 people are treated in Accident and Emergency and 1,300 babies are born in the maternity unit each year.

Bundled payment is the reimbursement of health care providers "on the basis of expected costs for clinically-defined episodes of care." It has been described as "a middle ground" between fee-for-service reimbursement and capitation, given that risk is shared between payer and provider. Bundled payments have been proposed in the health care reform debate in the United States as a strategy for reducing health care costs, especially during the Obama administration (2009–2016). Commercial payers have shown interest in bundled payments in order to reduce costs. In 2012, it was estimated that approximately one-third of the United States healthcare reimbursement used bundled methodology.

An accountable care organization (ACO) is a healthcare organization that ties provider reimbursements to quality metrics and reductions in the cost of care. ACOs in the United States are formed from a group of coordinated health-care practitioners. They use alternative payment models, normally, capitation. The organization is accountable to patients and third-party payers for the quality, appropriateness and efficiency of the health care provided. According to the Centers for Medicare and Medicaid Services, an ACO is "an organization of health care practitioners that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it".

<span class="mw-page-title-main">Isle of Wight NHS Trust</span>

The Isle of Wight NHS Trust is an NHS trust which provides physical health, mental health and ambulance services for the Isle of Wight. The trust is unique in being the only integrated acute, community, mental health and ambulance health care provider in England. It runs St Mary's Hospital and the Isle of Wight Ambulance Service.

Stockport NHS Foundation Trust is an NHS foundation trust, which runs Stepping Hill Hospital as well as other community and specialist services in Stockport.

The Five Year Forward View was produced by NHS England in October 2014 under the leadership of Simon Stevens as a planning document.

<span class="mw-page-title-main">Healthcare in Kent</span>

Healthcare in Kent has, from 1 July 2022, been mainly the responsibility of the Kent & Medway Integrated Care Board. Certain specialised services are directly commissioned by NHS England, coordinated through the South East integrated regional team. Some NHS England structures are aligned on a Kent and Medway basis, others on a South East basis and there is liaison with London to provide many tertiary healthcare services.

Healthcare in Somerset, England was the responsibility of three clinical commissioning groups (CCGs) until July 2022. These covered the ceremonial county of Somerset, which comprises the areas governed by Somerset County Council and the unitary authorities of North Somerset and Bath and North East Somerset.

The "Greater Manchester Model" of NHS health care was a system uniquely devolved within England, by way of close integration with the Greater Manchester Combined Authority and local authorities, led by the Mayor of Greater Manchester. In July 2022 the Greater Manchester integrated care system took over responsibility for health and social care in the conurbation. The financial plan for 2022-23 had an initial shortage of £187 million.

Healthcare in the West Midlands was, until July 2022, the responsibility of five clinical commissioning groups: Birmingham and Solihull, Sandwell and West Birmingham, Dudley, Wolverhampton, and Walsall.

Healthcare in Northumberland was the responsibility of the Northumberland, Newcastle Gateshead, and North Tyneside clinical commissioning groups from 2013 to 2022 before being replaced by integrated care systems.

Healthcare in Lancashire in 2015 was the responsibility of seven clinical commissioning groups covering Blackpool, Chorley and South Ribble, East Lancashire, Fylde and Wyre, Greater Preston, Lancaster North and West Lancashire. In 1 April 2017 32 GP practices from Cumbria Clinical Commissioning Group merged with Lancashire North CCG to form Morecambe Bay CCG which was abolished in July 2022 when integrated care systems were introduced.

Healthcare in Yorkshire from 2016 was the responsibility of 19 clinical commissioning groups, which were replaced by integrated care systems in July 2022.

Healthcare in Nottinghamshire was, until July 2022, the responsibility of six clinical commissioning groups, covering Nottingham City, Nottingham North & East, Mansfield and Ashfield, Newark and Sherwood, Rushcliffe, and Nottingham West. They planned to merge in April 2020.

In England, a sustainability and transformation plan (STP) is a non-statutory requirement which promotes integrated provision of healthcare, including purchasing and commissioning, within each geographical area of the National Health Service. The plans were introduced in 2016 but by 2018 had been overtaken by progress towards integrated care systems.

In England, an integrated care system (ICS) is a statutory partnership of organisations who plan, buy, and provide health and care services in their geographical area. The organisations involved include the NHS, local authorities, voluntary and charity groups, and independent care providers. The NHS Long Term Plan of January 2019 called for the whole of England to be covered by ICSs by April 2021. On 1 July 2022, ICSs replaced clinical commissioning groups in England.

References

  1. ↑ "What's the difference between an ACS and an ACO?". Health Care Leader. 10 August 2017. Archived from the original on 22 January 2018. Retrieved 3 October 2017.
  2. ↑ "ACSs get a rebrand as NHS England seeks 'next cohort'". Health Service Journal. 2 February 2018. Retrieved 2 April 2018.
  3. ↑ "Accountable care organisations (ACOs) explained". Kings Fund. 14 June 2017. Retrieved 13 July 2017.
  4. ↑ "Developing accountable care systems: lessons from Canterbury, New Zealand". Kings Fund. 24 August 2017. Retrieved 5 September 2017.
  5. ↑ Zanon, Elisabetta (17 November 2014). "The Alzira model gives us a great deal to think about". NHS Confederation. Retrieved 15 July 2017.
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