This document outlines the concept of an Accountable Care Organisation (ACO) proposed for Cambridge, England. The ACO would be a partnership between primary and secondary care providers to deliver care within a fixed budget. It would integrate services across home, community centers, and hospitals using a shared electronic patient record. The ACO aims to improve outcomes while reducing costs through clinical and financial integration. It would take on financial risk for the population it serves and be accountable to the NHS for outcomes. The document discusses potential advantages, priorities, and structure of the proposed ACO.

1. An outline of the Cambridge Accountable
Care Organisation (ACO) concept
James Morrow, GP, Sawston Medical Practice

2. Background

3. Our Vision
 Partnership between primary and secondary
care providers to deliver the best possible
clinical outcomes within a fixed budget
 Clinical teams moving seamlessly from home to community
centre to hospital
 Shared electronic patient record with patient access
 Financial alignment and risk sharing of a capitated budget
 Transforming academic excellence and research into on-the-
ground achievements for our population

4. Standard care model
Expertise
Location
Home General Practice Local Hospital Tertiary Centre

5. Doing less of the same
 “A man with a hammer
sees a lot of things
worth hammering”
Attr. Mark Twain
 “Insanity is doing the
same thing, over and
over again, but
expecting different
results"
Attr. Albert Einstein

6. What can we learn from 1782?
Thomas Whitcombe 1763-1824

7. Comte de Grasse Admiral George Rodney

8. Accountable Care Model
 A single provider organisation crossing
primary/secondary care boundaries
 Commissioned by NHS; accountable for outcomes
 Registered primary care population
 Capitated whole population budget
 Financial risk held on provider side

9. Breaking of the Line
Expertise
Location
Home Health Centre DGH Tertiary Hospital

10. Proposed ACO Structure
 A Community Interest Company run for the benefit of
the community, working in and with the community
 Jointly owned by primary and secondary care
 Board-level representation of patients, local authority
& both primary and secondary care clinicians
 Accountable to commissioners for outcomes, not
processes

11. The Integrated Care Model
Clinical
Governance:
Goals,
Targets,
Pathways
Mx
Annual Plan
Annual
Pharma- Assessment Practice
ceuticals Credentialing
Patient Education.
The person
T2 Education with P/N and GP
Primary Care
diabetes/ Structured
Education
Education
T2 Ongoing self care
Education
Other interval Practice Visits
T1 Education visits
Clinic Visits
T1 Ongoing
Education
Practitioner
credentialing
Carer
Education
Information Management
Clinical data Audit/ Population
sharing feedback Monitoring
D Simmons

12. ACO Advantages
 Alignment of financial interests
 Clinical integration across primary/secondary chasm
 Allows flexible use of human and financial resources
 Based around single shared electronic patient record
 Reduced transactional costs and bureaucracy

13. ACO Priorities
 Living within a finite budget
 Relentless focus on quality of care, safety,
outcomes, patient experience and careful use of
resources
 Flexibility around service provision
 Local accountability and shared decision making

14. Commissioner Benefits
 Simple commissioning structure
 Top-level outcomes specified, not micromanagement
of individual service specifications
 Capitated budget – transparent, fair and open
 Financial risk sits with provider, not commissioner

15. System Benefits
 Reduced waste, inefficiencies and transactional costs
 Shared records
 Better data for research, audit and outcome measures
 Better patient outcomes
 Setting the standard by which others are judged

16. Our Vision – Patient Services
 Local easy access to quality-assured health care
 Extended opening of primary care facilities. Full
range of diagnostics provided at local level.
 Ability to manage most conditions on-site, using
specialist knowledge when needed
 Rapid access to specialist opinion using shared
record

17. Competition
 ACO will, as a provider, have the ability to build or buy
services
 ACO will purchase from other providers including NHS,
independent and third sectors, where it is best use of
resources and clinically appropriate
 If ACO model delivers on quality and value then it sets
benchmark for other providers
 Growth/consolidation may occur but openness about
system and structure will permit others to emulate design
and compete

18. Scale
 Need to start small and be fleet of foot
 Risk sharing arrangements with phased adoption of
higher risk areas as size of organisation increases
 Risk from additional activity and random events mitigated
by movement from PBR (price) to true marginal cost and
shared ownership between primary and secondary care
 Growth by success

19. Risks
 Death by committee
 Regulatory, political and economic environments
 Delay
 Compromise of purpose
 Financial Failure

20. Making it happen
 Conceptual buy-in from primary and secondary care
 Permission to innovate
 Design of evaluation and reporting
 Identify resources to get going
 Agreement to commission (CCG)

21. Will it fly?
 “... Must ensure that we keep our current focus on
practice engagement and referral management to
give us the best chance of breaking even at the end
of the year...”
 “...We are not clear how your proposed model would
contribute in resolving this problem.”
Local Commissioning Group, August 2011

22. Our difficulty lies not so much in developing new ideas
as in escaping from the old ones
John Maynard Keynes
1883-1946

23. Dare Commissioners
“Break the Line”?
Thomas Whitcombe 1763-1824