Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event. Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development. This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being. More information is available online: www.expo.nhs.uk

1. Enabling New Models of Care: Practical Considerations

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Introductions
Ann Hepworth leads business
development in the UK. Joined Optum
18 months ago after 25 year career in
healthcare, both NHS and with
HealthSkills in OD.
Kira Levy leads Population Health
Solutions in the UK. Joined Optum 18
months ago, after 15 year career in
healthcare, both with NHS and
internationally. She is an epidemiologist.
Objectives of session
• Explore different model options on
the journey to integrated care
• Identify core capabilities required
• Provide practical examples and a
roadmap for success
• Provide opportunity for you to ask
questions from people who have
done this elsewhere

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Perceptions of challenges
• Lack of actionable intelligence
• Knowing where to start
• Identifying optimal model design
• Workforce development
• Value-based contracting and payment models: transitioning to capitation:
understanding risk
• Technology and infrastructure requirements
• Activation of patients and families in managing their own health
• Cross-system engagement, leadership and governance

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Optum: our mission
‘To help people live healthier lives,
and to help make the health system work
better for everyone’

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Connecting and serving the health system
Healthier
Life Sciences
1 million people
Receiving home
visits
300
Health plans
2 million
people
Receiving care in
one of 24 Optum-
run ACOs
50 million lives
On which we take risk globally Pharmacies
74 million
Consumers, including 25
million outside US

6. The ACO
experience…
• Lessons from international best practice

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Optum Collaborative Care ‘ACO’ business
A Strong Foundation Built On Local Partnerships

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Why population health?
• Increasing costs – reactive, fragmented,
activity-based systems no longer fit for
purpose in light of growing LTCs
• Lower than desired quality outcomes due to
lack of coordination and difficulties for patients
and clinicians to navigate health systems
• Variable access
• Changes in provider landscapes (e.g.
increasing pressure on primary care systems
globally)
Internationally, drivers of population health are similar
Population health is a
proactive, patient-centric
approach that engages
patients, clinicians and
providers in wellness,
prevention, care coordination
and management, improving
outcomes and reducing costs.

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No single ‘right’ model

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US Experience: Moving along value-based spectrum

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Core population health capabilities

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Primary Care / GP - led example: WellMed (an Optum company)
Primary Care based ACO headquarters in San Antonio, TX, with additional markets
throughout TX and in Tampa FL 60+ physicians in 20+ clinics
Early model Primary Care Medical Home / Primary Care ACO– WellMed has been one of
the earliest adopters of a primary care driven, non-hospital ownership model for population
health. They have been operating under a Global Capitation / Full Delegation model with
various insurers for 15+ years.
Senior Population focused: Primary focus is on adults 65+ (Medicare population).
Primary care physician base is a mix of Geriatricians, Internal Med and Family Practice.
Community Centers: Partnership with City of San Antonio has resulted in multiple
senior-focused community centers that have daily average attendance of 600+ visitors
Coverage:Population includes delegated financial risk on 100,000 + patients in addition to
regular fee-for service patient panels.

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WellMed: Solutions to business challenges
• Delegated, Full Global Risk capitation contracts with multiple payers
• Full data warehouse of claims and clinical EHR data
• Community Centers attached to GP Surgeries
• Longitudinal data across multiple providers available becauseWellMedhas financial responsibility for
global health budget and has access to all touch points
• Predictive Risk models that identify high-risk patients, next tier at risk
• Monthly reporting and feedback on panels to GPs on total population
• Partnership with City of San Antonio for building Community Centres which function as group education,
fitness classes, etc.
• Transportation benefits to bring Seniors to Surgeries
• GPs paid on salary with 40% of total compensation basedon performance outcomes (quality and utilisation)
• Strong partnership with Acute hospitals to staff “hospitalists” on-site
• Data sharing and benchmarking across all physicians and providers
• Multi-specialty care teams (GP, Pharmacist, Nutritionist, Mental Health, Social Worker, etc.) do shared
surgery visits
• Single coordinated care plan that covers home visits, telephonic and on-line support and is shared with
other providers in the market
• Proactive outreach to risk patients for an annual assessment (vs. problem driven)

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Primary care led example: 65+ population

15. Translating to
the UK…

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Dorset Integrated Wellness Model
• Purpose to protect and improve health and wellbeing,
enabling sustainable behaviour change in key lifestyle
areas
• Central Hub promotes and provides the service directly and
indirectly through single point of access to 750,000
population
• Opportunity to move away from fragmented silos of
service, and towards a more holistic model; empowering
consumers to take ownership of their health and wellbeing
• Team of Wellness Advisors and Coaches: COM-B
approach to assessment and tailored intervention planning
plus range of Tier 1 brief interventions
• Targeted outreach and social marketing: a universal
offering, also actively engaging communities and promoting
the service to ‘hard to reach’ groups where health
outcomes are poorest.

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Livewell Dorset service model
• Telephonic call centre
• Referral facilitation service
• Shared care managementtool (in development)
• Robustdata capture and outcome recording
• Analytics to evaluate and adaptservice model
• Reportsharing with partners
• Proactive outreach to hard-to-reach communities,using assets based approach
• Comprehensive marketing and communication programme
• Online engagementtools
• 1:1 wellness planningbased on individual goals (using COM-B)
• Comprehensive service directory
• Network of collaborative partners,including3rd sector
• Outcomes tracking across service users
• Provision oftraining and upskilling to key partners
• Delivery of Tier 0 and 1 brief advice and interventions aroundsmoking cessation,health eating,
physical activity and alcohol

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Early outcomes
• Successful engagement with GPs and local voluntary network – strong relationships with
local CVS, Health Promotion Devon, Community Action Dorset and Healthwatch
• Re-trained local staff as Wellness Advisers and Coaches
• Re-branded and launched LiveWell Dorset, a single point of access service – ‘one
number, one website, one front door)
• Received over 300 contacts in month 1 including:
– 50% from GP surgeries
– 26% self-referrals
– 49% of people accessing service are from top 40% most deprived areas in Dorset

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Implications for New Models of Care
• No right way to deliver new models of care
• Different approaches with different rewards/risks – layers of protection as you build
confidence in working differently
• Requires new capabilities, new relationships and new ways of working
• No perfect ‘starting point’ – understand where you are on curve and where
you want to go
• Be realistic – population health requires upfront investment for long term benefits
– what can you be doing now to
plan for future?

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Questions
?

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Visit the Optum Stand 4
• Website: optum.co.uk
• Email: info@optum.co.uk
• Telephone: 020 7121 0560