This document summarizes an upcoming webinar on encouraging collaboration through contractual mechanisms for integrated care. The webinar will discuss three contractual models - prime contracts, prime provider contracts, and alliance contracts - used in different areas of England. It will cover underlying principles of contracting for integrated care like focusing on outcomes and service integration. The webinar aims to help participants understand different contract features and terms that encourage collaboration, and appreciate the commitment involved in contracting for integrated care. The document provides contact information for the webinar presenters and a link to register.

1. WELCOME
Wednesday 4 February 2015
Webinar
The Organisation of Integrated Care

2. The Organisation of Integrated Care:
Encouraging collaboration through contractual
mechanisms
Wednesday 4 February 2015
1pm – 1.45pm
Dr Rachael Addicott
Senior Research Fellow, The Kings Fund
&
Beverley Matthews
LTC Programme Lead, NHS Improving Quality

3. Beverley Matthews
LTC Programme Lead
NHS Improving Quality
Beverley.matthews@nhsiq.nhs.uk

4. www.england.nhs.uk
LTC Year of Care Commissioning
Programme:
4
• 5 Early Implementer sites
• 35 Fast Followers
• Whole Population Datasets
• Implementation Guide
• Simulation Modelling
• Specialist Support Team

5. www.england.nhs.uk
LTC Framework Improvement
Programme:
5
Organisational &
Clinical
Processes
Informed and
engaged patients
and carers
Health & Care
Professionals
committed to
partnership
working
Commissioning
• Information and
technology
• Case finding & risk
stratification
• Care Planning
• Safety and
Experience
• Guidelines,
evidence and
national audits
• Care Delivery
• Self Management
• Information and
Technology
• Group and Peer
Support
• Care Planning
• Policies for carers
• Voluntary sector
patient & carer
support
• HSC Integration
• Multi Disciplinary
Teams
• Culture
• Workforce
• Technology
• Care Co-
ordination
• Care Planning
• Needs
Assessment and
Planning
• Joint
Commissioning
• Metrics and
Evaluation
• Service User and
Public Involvement
• Contracting and
Procurement
• Care Planning
• Tools and Levers
The table below sets out some of the key components needed to deliver the central
aim for LTC Framework - Person Centred Coordinated Care

6. Long Term Conditions Dashboard
http://ccgtools.england.nhs.uk/ltcdashboard/flash/atlas.html
Long Term Conditions House of Care Toolkit
www.nhsiq.nhs.uk/improvement-programmes/long-term-conditions-and-integrated-care/house-of-care.aspx
Simulation Model
http://www.simul8.com/viewer/download.htm
#LTCyearofcare #LTCimprovement @NHSIQ
Tools and Resources:

7. www.england.nhs.uk
LTC Learning Community:
7
• Lunch & Learn Webinar Series
• Bite Size Master Classes
• Case Studies and Exemplars
• Twitter Chats
• Google Hangouts

8. To register email LTC@nhsiq.nhs.uk
Date Webinar Hosted by Bev Matthews &
25 February @ 1pm NHS Commissioning Assembly
Technology Enabled Resource
for Commissioners
Annie Thompson
NHS England
4 March 2015 Primary Care Workforce in the
21st Century
Sharon Lee
Queens Nurse, Primary Care
Workforce Facilitator, South Kent
Coast CCG
To be confirmed SIMUL8/ Simulation Tool Fionuala Bonnar
Year of Care Programme Manager
Public Health, Kent County Council
Kent Early Implement Sites (LTC
Year of Care Commissioning)
LTC Lunch & Learn Series
….coming soon…

9. The Organisation of Integrated Care: encouraging
collaboration through contractual mechanisms
• Understand the features of three different contractual
models, including their advantages and challenges of each.
• Be aware of the underlying principles of contracting for
integrated care, and be able to consider contract terms that
courage collaboration.
• Appreciate and plan for the commitment, resources and
responsibilities involved in contracting for integrated care.
of Care foundation.
Learning Outcomes
for today’s Lunch & Learn

10. THE ORGANISATION OF
INTEGRATED CARE:
Encouraging Collaboration through
Contractual Mechanisms
Rachael Addicott
r.addicott@kingsfund.org.uk

11. 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

12. New contracting models
› Accountable Care Organisations
› United States
› Prime contractor / prime provider
› Back-to-work programs in Australia and the United States
› Alliance contracting
› Australian construction industry
› New Zealand health care
All focus on integrated delivery of care

13. Staffordshire Bedfordshire Cambridgeshire Lambeth Salford
Focus of
contract
Cancer and end of life
care (separate
procurements)
Musculoskeletal care Older people and adult
community services
Integrated personal
support (mental health
rehabilitation)
Older people
Contract type Prime contract
(integrator)
Prime contract
(integrator)
Prime provider contract Alliance contract Alliance contract
Main partners
in contract
development
• Local health
commissioners
• NHS England (cancer
only)
• Public Health
England
• Macmillan Cancer
Support
• Local health
commissioners
• Circle (independent
sector provider)
appointed as prime
contractor
• Local health
commissioners
• Local health
commissioners
• Local authority
(responsible for
social care)
Provider alliance:
• Voluntary sector
providers
• Mental health
hospital
• Adult social care
• Alliance:
• Local health
commissioners
• Local authority
• Acute hospital
• Mental health
hospital
• GP provider
consortium is an
‘honorary’ member
Motivation
for change
• Fragmentation
• Poor access,
outcomes and
patient experience
• Fragmentation
• Value for money
• Access problems
• Variable expenditure
and quality of care
• Population growth
• Constrained finances
• Fragmentation of
existing pathways
and provision
• Desire to focus on
outcomes rather
than activity
• To improve quality
of care
• Manage costs
• Overcome
limitations of
informal
collaboration
• Overcome
limitations of
informal
collaboration
• Population growth
Estimated
contract value
£1.2 billion (approx.
£120 million per year)
£169 million (approx.
£27 million per year)
£800 million (£160m in
the first year)
£24 million (£8 million
per year)
Approx £700 million
(£98 million in the first
year)
Length of
contract
10 years 5 years 5 years (option of
additional 2 years)
2 years (option of
additional 1 year)
3½ years (option of
additional 3 years)

17. Underlying principles of
organisational integration
› Outcomes
› Service integration
› Aligned payment mechanisms

18. Ongoing challenges
› Political sensitivities
› New competencies – supply chain management; procurement
› Time and resources
› Sources of support and guidance
› Scope and boundaries:
› Cost shifting and risk shifting
› Defining a budget

19. Four points 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

20. More information
› Alternative guide to the NHS:
http://www.kingsfund.org.uk/projects/nhs-65/alternative-guide-
new-nhs-england
› Accountable Care Organisations in the United States and England:
http://www.kingsfund.org.uk/publications/accountable-care-
organisations-united-states-and-england
› Commissioning and contracting for integrated care:
http://www.kingsfund.org.uk/publications/commissioning-
contracting-integrated-care

21. The Organisation of Integrated Care: encouraging
collaboration through contractual mechanisms
• Understand the features of three different contractual
models, including their advantages and challenges of each.
• Be aware of the underlying principles of contracting for
integrated care, and be able to consider contract terms that
courage collaboration.
• Appreciate and plan for the commitment, resources and
responsibilities involved in contracting for integrated care.
of Care foundation.
Disscussion:

22. To register email LTC@nhsiq.nhs.uk
LTC Lunch & Learn Series
….coming soon…
Date Webinar Hosted by Bev Matthews &
25 February @ 1pm NHS Commissioning Assembly
Technology Enabled Resource
for Commissioners
Annie Thompson
NHS England
4 March 2015 Primary Care Workforce in the
21st Century
Sharon Lee
Queens Nurse, Primary Care
Workforce Facilitator, South Kent
Coast CCG
To be confirmed SIMUL8/ Simulation Tool Fionuala Bonnar
Year of Care Programme Manager
Public Health, Kent County Council