This document discusses organizing integrated care and defines accountable care organizations (ACOs). It explains that ACOs aim to coordinate care across providers through shared governance, quality metrics, and risk/reward incentives. The document outlines different approaches to accountability, from soft influences to hard penalties. It also notes challenges in England around defining accountability, budgets, and balancing choice/competition with integration goals.

2. The Organisation
of Integrated Care
Rachael Addicott, Senior Research Fellow
r.addicott@kingsfund.org.uk
@RachaelAddicott

3. Why?

4. 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

5. How?

7. › Primary and Acute Care Systems
(PACS) would provide list-based GP
and hospital services, together with
mental health and community care,
in single NHS organisations
› Could take accountability for the
whole health needs of a registered
list of patients, under a delegated
capitated budget
› Similar to Accountable Care
Organisation model

8. Are we all talking about the same thing?

9. …or a progression?

10. So, what is
an ACO?

11. › Group of providers that accept accountability for the cost and
quality of care provided to a defined population of potential patients
› Coordination of care across a network of providers
› Interdependency: cost savings more likely if partners work together
› Defined patient population
› Care management and predictive risk modelling
› Shared governance structure (ie. ACO Board)
› Shared accountability for quality and cost of care
› Shared risk and savings: on condition of meeting quality metrics

14. 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

15. Experience of organising integrated care in
England
› Who’s accountable for integration?
› Purchaser provider split = contractual solutions
› Baby steps leading to problems in scope and boundaries
› Cost shifting and risk shifting
› New competencies – eg. supply chain management
› Defining a budget
› Choice and competition?

16. 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