Commissioning and integrated care aims to improve coordination and alignment of incentives across health and social care. Integrated care organizations bring together providers from different sectors to provide seamless, patient-centered care. Emerging models in the UK include integrated primary, community, and secondary care organizations, as well as partnerships between health and social care providers. While evidence on outcomes is still limited, integrated models show promise for improving efficiency and care for patients with complex needs. National policies on payment systems, provider competition, and performance measurement will influence how integrated care continues to evolve in the UK.
Slides from the workshop 'A modern vision of integrated care and support' led by Dr Martin McShane, Dr Damian Riley (NHS England) and David Pearson (ADASS) - NHS Medical Leaders Conference 2014. - See more at: http://www.icase.org.uk/pg/cv_content/content/view/98680#sthash.45Xs2o9r.dpuf
Steve Laitner on integrated care - innovations in the UKThe King's Fund
Dr Steve Laitner, GP and Associate Medical Director of NHS East of England, discusses integrated care innovations in the UK with a focus on pathway hubs.
Judith Smith and Chris Ham: Commissioning integrated care - what role for cli...The King's Fund
Dr Judith Smith, Head of Policy at the Nuffield Trust, and Professor Chris Ham, Chief Executive of The King’s Fund, share the findings of their recent research into how NHS commissioners have been commissioning better integrated services and care for people in local areas.
Slides from the workshop 'A modern vision of integrated care and support' led by Dr Martin McShane, Dr Damian Riley (NHS England) and David Pearson (ADASS) - NHS Medical Leaders Conference 2014. - See more at: http://www.icase.org.uk/pg/cv_content/content/view/98680#sthash.45Xs2o9r.dpuf
Steve Laitner on integrated care - innovations in the UKThe King's Fund
Dr Steve Laitner, GP and Associate Medical Director of NHS East of England, discusses integrated care innovations in the UK with a focus on pathway hubs.
Judith Smith and Chris Ham: Commissioning integrated care - what role for cli...The King's Fund
Dr Judith Smith, Head of Policy at the Nuffield Trust, and Professor Chris Ham, Chief Executive of The King’s Fund, share the findings of their recent research into how NHS commissioners have been commissioning better integrated services and care for people in local areas.
Chris Ham on making integrated care happen at scale and paceThe King's Fund
Chris Ham, Chief Executive at The King’s Fund, highlights the 16 lessons needed to make a reality of integrated care, drawing on work by the Fund and others to provide examples of good practice.
Jacquie White, Deputy Director of NHS England Long Term Conditions, Older People & End of Life Care and Claire Cordeaux SIMUL8 Executive Director for Health & Social Care were invited by Centers for Medicare & Medicaid Services to discuss how NHS England work in chronic disease.
Malawi Mid-Year Review 2014-2015 Health Insurance Reformmohmalawi
Malawi Mid-Year Review 2014-2015
An overview of the discussion at the Expert Panel on Health Insurance
A look at the health sector reforms currently underway in Malawi
Much of this growth came about in response to the cost-cutting and restructuring that occurred beginning in the late 1990s under managed care programs. Large health- care chains fought unionization efforts with intimidating one-on-one meetings with employees, mandatory “captive audience” sessions with larger groups, and an onslaught of literature that sought to mislead workers about the union.
Cette croissance est une réponse aux réductions des coûts et autres restructurations qui ont commencé dès le début des années 1990. Les grandes chaînes de soins hospitaliers ont combattu les tentatives de syndicalisations avec des entretiens un-à-un intimidant les employés, des sessions magistrales obligatoires, ainsi que divers documents destinés à tromper les employés dans leurs perceptions d'un syndicat.
DR TIM LEIGHTON AND KATHERINE JENKINS - WHAT CAN THE PAST TEACH US ABOUT THE ...iCAADEvents
The presentation and workshop will be a participatory session discussing the future of addictions counselling, and how decades of experience can inform best practice whilst also combining cutting edge research and treatment methods. Addictions counselling with individuals, couples, families and groups has become more complex and challenging. How can we de ne and describe the training and quali cations needed to ensure the best practice and the most e ective interventions? What is the relationship between the quality framework and the therapeutic work? The workshop will explore tensions that arise in practice as experienced by the audience, and suggest ways to get the training, support and continuing professional development you need. Tim and Katherine will be encouraging the audience to share their own thoughts and ideas.
Background: A unique statewide multipayer initiative in Pennsylvania was undertaken to implement the Patient-Centered Medical Home (PCMH) with diabetes as an initial target disease. it is and one of the largest PCMH multipayer
initiatives.
Results: During the first intervention year (May
2008–May 2009), all practices achieved at least Level 1 National Committee for Quality Assurance (NCQA) Physician
Practice Connections Patient-Centered Medical Home
(PPC-PCMH) recognition. There was significant improvement in the percentage of patients who had evidence-based
complications screening and who were on therapies to reduce morbidity and mortality (statins, angiotensin-converting enzyme inhibitors). In addition, there were small but statistically significant improvements in key clinical parameters for blood pressure and cholesterol levels, with the greatest absolute improvement in the highest-risk patients.
Conclusions: Transforming primary care delivery through
implementation of the PCMH and CCM supported
by multipayer infrastructure
Chris Ham on making integrated care happen at scale and paceThe King's Fund
Chris Ham, Chief Executive at The King’s Fund, highlights the 16 lessons needed to make a reality of integrated care, drawing on work by the Fund and others to provide examples of good practice.
Jacquie White, Deputy Director of NHS England Long Term Conditions, Older People & End of Life Care and Claire Cordeaux SIMUL8 Executive Director for Health & Social Care were invited by Centers for Medicare & Medicaid Services to discuss how NHS England work in chronic disease.
Malawi Mid-Year Review 2014-2015 Health Insurance Reformmohmalawi
Malawi Mid-Year Review 2014-2015
An overview of the discussion at the Expert Panel on Health Insurance
A look at the health sector reforms currently underway in Malawi
Much of this growth came about in response to the cost-cutting and restructuring that occurred beginning in the late 1990s under managed care programs. Large health- care chains fought unionization efforts with intimidating one-on-one meetings with employees, mandatory “captive audience” sessions with larger groups, and an onslaught of literature that sought to mislead workers about the union.
Cette croissance est une réponse aux réductions des coûts et autres restructurations qui ont commencé dès le début des années 1990. Les grandes chaînes de soins hospitaliers ont combattu les tentatives de syndicalisations avec des entretiens un-à-un intimidant les employés, des sessions magistrales obligatoires, ainsi que divers documents destinés à tromper les employés dans leurs perceptions d'un syndicat.
DR TIM LEIGHTON AND KATHERINE JENKINS - WHAT CAN THE PAST TEACH US ABOUT THE ...iCAADEvents
The presentation and workshop will be a participatory session discussing the future of addictions counselling, and how decades of experience can inform best practice whilst also combining cutting edge research and treatment methods. Addictions counselling with individuals, couples, families and groups has become more complex and challenging. How can we de ne and describe the training and quali cations needed to ensure the best practice and the most e ective interventions? What is the relationship between the quality framework and the therapeutic work? The workshop will explore tensions that arise in practice as experienced by the audience, and suggest ways to get the training, support and continuing professional development you need. Tim and Katherine will be encouraging the audience to share their own thoughts and ideas.
Background: A unique statewide multipayer initiative in Pennsylvania was undertaken to implement the Patient-Centered Medical Home (PCMH) with diabetes as an initial target disease. it is and one of the largest PCMH multipayer
initiatives.
Results: During the first intervention year (May
2008–May 2009), all practices achieved at least Level 1 National Committee for Quality Assurance (NCQA) Physician
Practice Connections Patient-Centered Medical Home
(PPC-PCMH) recognition. There was significant improvement in the percentage of patients who had evidence-based
complications screening and who were on therapies to reduce morbidity and mortality (statins, angiotensin-converting enzyme inhibitors). In addition, there were small but statistically significant improvements in key clinical parameters for blood pressure and cholesterol levels, with the greatest absolute improvement in the highest-risk patients.
Conclusions: Transforming primary care delivery through
implementation of the PCMH and CCM supported
by multipayer infrastructure
Question of Quality Conference 2016 - Patient Experience - Innovation in pati...HCA Healthcare UK
The South Somerset Symphony Programme is one of nine Primary and Acute Care systems (PACs) Vanguards born out of Simon Stevens’ Five Year Forward View. To address the problems of an ageing population and an increased burden of long-term conditions, it is essential to have a coordinated response across sectors, putting the patient at the centre of care. The session will look at a joint venture that will hold a single budget for the population and how this enables them to target resources to parts of the system where they can make the most difference to patients.
Evaluation of IC initiatives - challenges, approaches and evaluation of Engla...Sax Institute
This presentation from Nicholas Mays, Professor of Health Policy, Director, Policy Innovation Research Unit, Department of Health Services Research & Policy focuses on the challenges, approaches and evaluation of England's Pioneers.
New Business Models and Primary Care ContractingNHS England
General Practice Transformation Champions conference, 22 November 2017
Workshop 3.5 New Business Models and Primary Care Contracting - Led by Ed Waller & Paul Maubach
We at Boehringer Ingelheim know that there are many issues affecting health care in the United States. In this presentation Dr. Lee Sacks of Advocate Health takes a look at accountable care organizations (ACOs) and their role in health care reform. Understanding the Implications of Accountable Care Organizations for Patients and Providers, was a web conference given on July 31, 2012 and which we hope will provide offer an understanding of best practices among ACOs and tips for helping constituents adopt and participate in ACOs.
Evaluation of the Integrated Care and Support Pioneers ProgrammeNuffield Trust
Nick Mays of the Policy Innovation Research Unit presents some conclusions from the early evaluation of the Integrated Care and Support Pioneers Programme.
Chapter 4Determinants of the Utilization of Health Car.docxketurahhazelhurst
Chapter 4
Determinants of the
Utilization of Health Care Services
*
LEARNING OBJECTIVES
What are the main factors driving people to seek health care?
How are people influenced by their personal characteristics (such as age, gender, race, income and education) in seeking health care?
What are the main factors and forces that reduce the demand for health care?
What are the main factors that tend to increase the demand for health care?
How do health care coverage and incidence vary geographically?
LO1. What are the main factors driving people to seek health care?Known illness, accident, or injurySymptomsPrevention/check-upSecond opinionLegalAdministrativeDiscretionary
*
Key Words:
LO1. What are the main factors driving people to seek health care? (cont)It is important to identify what type of services is involvedthe reason the patient is seeking carethe relevant stakeholders for the encounterthe personal characteristics that influence the likelihood that an individual will seek care
*
Key Words:
LO2. How are people influenced by their personal characteristics (such as age, gender, race, income and education) in seeking health care?
AgeFirst two years of lifeWomen of childbearing yearsElderlyGenderWomen more than men
*
Key Words:
LO2. How are people influenced by their personal characteristics (such as age, gender, race, income and education) in seeking health care? (cont)
RaceDifficult category to defineDifferences can often be explained by basis of socioeconomic or education differencesCannot assume uniformity within any racial or ethnic groupIncome - helps determine which services are usedEducation - varied
*
Key Words: culture
LO3. What are the main factors and forces that reduce the demand for health care?
Consumer factorsDriven by insurance payers, medical groups, and pharmaceutical benefits management companiesIncrease out-of-pocket expensesDisease preventionElimination or reduction of risky behaviorsSelf-management and educationEnd-of-life issuesPromotion of healthier lifestyle
*
Key Words: consumer-driven healthcare, social marketing, rationing, futility
LO4. What are the main factors that tend to increase the demand for health care?
Provider factorsDriven by profit(?), environmental and cultural events Ways to limit costsDecreasing feesIncreasing or decreasing the number of providersChanging the payment methodReviewing utilization more carefullyImplementing practice guidelines
*
Key Words: provider-induced demand (PID)
LO5. How do health care coverage and incidence vary geographically?
Extreme variations in patterns of careNot related to variation in illness patternsCan be related to Differences in health care systemsDifferences in physicians’ practice stylesPhysicians’ own beliefs about effectiveness of careMedical trainingBeliefs in own abilityDifferences in patient characteristics
*
Key Words:
CONCLUSION
Key factors affect people’s decision to seek health care.Demand is reduced by s ...
Workshop 5 - Brainstorming & Policy Development session: Social Aspects
"Feedback from the 15 National Conferences on social aspects"
Britta Berglund, Ehlers Danlos, Sweden
Effectiveness of the current dominant approach to integrated care in the NHSNuffield Trust
Jonathan Stokes of the Greater Manchester Primary Care Patient Safety Translational Research Centre presents a systematic review of case management in integrated care.
Providing actionable healthcare analytics at scale: Understanding improvement...Nuffield Trust
Thomas Woodcock, Improvement Science Fellow at Imperial College London, talks about the various measurement approaches and processes when working at large scale to assess care quality improvements.
Ramani Moonesinghe, Associate National Clinical Director for Elective Care at NHS England, discusses the use of data for monitoring care quality at various levels within the system.
Paul Aylin, Co-Director of the Dr Foster Unit at Imperial College London, gives concrete examples of using a specific statistical model for monitoring care quality, cumulative sum (CUSUM).
Martin Utley, Director of the Clinical Operational Research Unit at University College London, reflects upon his involvement in the launch of specific tools to monitor care quality for paediatric cardiac surgery.
Evaluating new models of care: Improvement Analytics UnitNuffield Trust
Martin Caunt, Improvement Analytics Unit Project Director and NHS England and Adam Steventon, Director of Data Analytics at The Health Foundation share insights into how they have approached evaluating new models of care.
Lisa Annaly, Head of Provider Analytics at the Care Quality Commission, discusses lessons learned from the CQC as they have worked to monitor care quality over time.
Kate Silvester, a healthcare systems engineer, discusses the challenges of working with data and statistical techniques for real-time monitoring of care quality.
Monitoring quality of care: making the most of dataNuffield Trust
Chris Sherlaw-Johnson, Senior Research Analyst at the Nuffield Trust, introduced the Monitoring quality of care conference and gives an overview of some of the approaches that we've been using at the Trust to identify where care quality has been improving, especially for frail and older people.
Providing actionable healthcare analytics at scale: Insights from the Nationa...Nuffield Trust
Christopher Boulton, Falls and Fragility Fracture Audit Programme Manager at the Royal College of Physicians and Rob Wakeman, Clinical Lead for Orthopaedic Surgery at the National Hip Fracture Database talk about what they have learned by analysing the national hip fracture database.
Providing actionable healthcare analytics at scale: A perspective from stroke...Nuffield Trust
Benjamin Bray, Research Director and the Sentinel Stroke National Audit Programme, presents at the Monitoring quality of care conference about stroke care analytics.
New Models of General Practice: Practical and policy lessonsNuffield Trust
Nuffield Trust policy researchers Rebecca Rosen and Stephanie Kumpunen present findings from our upcoming report on large scale general practice models.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. Outline
1. Current context
2. Commissioning
3. Why integrated care?
4. What is integrated care?
5. What forms are evolving?
6. What is the evidence that integrated care has impact?
7. Next steps
8. In conclusion
3. 1. Current context: some features
Financial challenge
Rising demand
System incentives misaligned
Unengaged clinicians
Weak commissioning
Avoidable ill health and costs
5. A view from the US
“The current care systems cannot do the job.
Trying harder will not work, changing systems of
care will.”
Need systems of care in which “clinician and
institutions… collaborate and communicate to
ensure appropriate exchange of information and
co-ordination of care”
(Institute of Medicine, Crossing the Quality Chasm, 2001)
6. 2. Commissioning
‘needs assessment, resource allocation,
service purchasing, monitoring and review’
Objective: health
Incentives currently not aligned in system
7. Commissioning
History
– Impact
– Small
– Transaction costs
Now
– PBC limp
– PCTs:
Little control over volume
New
Managerial and analytic capacity
Performance management
8. 3. Why integrated care?
Biggest efficiency frontier:
Care of older people
Care of people with long term conditions
Avoidable emergency admissions
9. Rising emergency admissions
Year- Increase
HES on-year against
increase 2004/05
2004/05 4,441,224 - -
2005/06 4,666,347 5.1% 5.1%
2006/07 4,707,975 0.9% 6.0%
2007/08 4,771,541 1.4% 7.4%
2008/09 4,964,344 4.0% 11.8%
NB: These numbers differ very slightly (<0.1%) from nationally
published because of the method used to assign spells to years
11. 4. What is integrated care?
Integrated care…
‘...imposes the patient’s perspective as the organising principle of
service delivery and makes redundant old supply-driven models
of care provision. Integrated care enables health and social
care provision that is flexible, personalised, and seamless.’
(Lloyd and Wait, 2005)
Integrated organisations…
12. Types of integration I
Vertical
- combination of services from different sectors into a
single organisation, perhaps across a care pathway (e.g.
merged hospital and community care organisation or
service)
- Payer/provider, provider
Horizontal
- combination of two or more services from the same
sector into a network or organisation (e.g. joint general
practice and community health care teams for people
with LTCs)
13. Types of integration II
Internal
- bringing together different
providers/commissioners within the NHS
External
- bringing together different NHS
providers/commissioners with others from
social care and beyond
14. Types of integration III
Virtual integration
- a network of collaborators
Real integration
- a single organisation
15. 5. What forms are evolving?
Health care examples
Integrated primary, community and secondary
health care
– Integrated care pilots (16) went live in April
2009
– Rooted in registered population
– Vary significantly in scale, focus and scope
– Programme expanded in February 2010
16. More radical health care examples
Whipps Cross and Redbridge polysystems, based
around integrated health centres, and with clinical
budget-holding and leadership
Trafford ICO, a whole system integration effort,
including primary and community services,
outpatients, office medicine/acute medicine/family
medicine
Possible foundation trust vehicle with
capitated budget.
Development towards multispecialty ‘office
medicine’
17. Trafford: current service sectors
PCT Acute provision
PCT
Inpatient,
Community Non-PbR daycase,
services services specialist
Outpatients
and
diagnostics
(Independent)
GP1 GP3 GPn
GP2 GP4 Are these demarcations
necessarily helpful?
18. Formalising clinical leadership/
enhancing local control
A FOUNDATION TRUST?
A FOUNDATION TRUST…?
Consultants, GPs and
nurses/ AHPs as
partners?
Non-PbR Inpatient, day
Community services Outpatients case,
services and specialist
diagnostics
Integrated Care Record
(Independent)
GP1 GP3 GPn
GP2 GP4
…MADE UP OF ‘MEMBERS’ ON GP LISTS…?
19. What forms are evolving?
Health and social care examples
Flexibilities in section 31 of the Health Act
1999:
– Lead commissioning
– Integrated provision
– Pooled budgets
Care trusts
20. More radical health and social care
examples:
Torbay Care Trust
Focus on care for ‘Mrs Smith’
LA social care staff TUPE’d into the NHS
5 integrated teams around groups of practices
Single management of each team, with pooled
budgets
Single assessment process
A health and social care co-ordinator as single
point of contact
Source: ‘Only Connect: policy options for integrating health and social care’.
Ham C.
21. NE Lincolnshire Care Trust Plus
Adult social care commissioning and
provision now transferred from LA to PCT
Public health transferred from PCT to LA
Joint health and social care teams
A single care assessor/co-ordinator with
pooled budgets
Source: ‘Only Connect: policy options for integrating health and social
care’. Ham C.
22. Challenges faced by these examples
Time and effort required
Risk averse culture of the NHS
Stable leadership and focus
Professional and cultural change
Establishing appropriate incentives (e.g. GMS)
Making sense of integrated care within the context of
other national policies
– Payment by Results
– Foundation trusts
– Competition and Co-operation Panel
23. 6. What is the evidence that integrated
care has an impact?
Limited – a lot on processes, much less on
outcomes
Quite a lot from the US
More recently, evidence from other more
comparable health care systems
Nuffield Trust about to commence a review of the
evidence on integrated care and efficiency
Source: Ramsay A and Fulop N. King’s College, London, 2008.
24. 7. Next steps
The General Election and subsequent policy direction
Integrating care as part of the financial challenge
New generation PBC? The potential of new forms of
primary/community based providers based on
medical groups
Determining how far it matters whether provision
and commissioning are separate
Working out how to ensure some choice and
contestability, and avoid provider monopoly
25. Policy barriers or enablers
PBC
How would capitation work alongside
Payment by Results?
Is it time to reform the GMS and PMS
contracts, to assure alignment of incentives?
How should integrated care be measured and
regulated, and by whom?
Competition
26. 8. In conclusion
Local providers and commissioners are getting
on with developing new forms of integrated
care
Evolution not revolution
Piloting of radical examples makes sense
Rigorous national evaluation is critical (cost,
quality and outcomes)