Making sense of integrated care systems

Title: Making sense of integrated care systems, integrated care partnerships and accountable care organisations in the NHS in England

A policy briefing is available for LKS staff to share in their organisations.  Produced by the JET Library at Mid Cheshire Hospitals NHS Foundation Trust.  Feel free to reproduce it (with acknowledgement).

What does this mean for libraries? 

• Share this resource with colleagues who are involved in the creation of integrated care systems, integrated care partnerships, accountable care systems and accountable care organisations.
• There may be an opportunity to deliver evidence and knowledge to managers, commissioners and transformation teams as health care services undergo this change.
• As organisational boundaries blur and take a ‘whole population’ approach, LKS may be required to adapt their service delivery models accordingly.
• If healthcare moves away from a competitive structure and towards a collaborative one, there will be many opportunities relating to knowledge management that could support the sharing and dissemination of good practice, innovation and organisational knowledge.
• LKS will have to consider how the negotiation and procurement of resources needs to adapt to reflect the changes in organisational structures.
• There is a clear role for technology in supporting the emergence of integrated care systems and Accountable Care Organisations that presents an opportunity for digitally enabled LKS.

Source: King’s Fund

Link to main document 

Date of publication: February 2018

Summary of driver:  Crucially, this document indicates that the first wave of 10 “shadow accountable care systems” being supported by NHS England have been renamed Integrated Care Systems. This name describes more accurately the work being carried out. The long read outlines that integrated care is being tackled differently in different places and a variety of terms are being used. For the purpose of this document, the following are defined as being the main 3 approaches to integrated care:

• Integrated care systems (ICSs)
• Integrated care partnerships (ICPs)
• Accountable care organisations (ACOs)

The document also outlines the new care models, provides an update on the 10 integrated care systems, discusses the controversy around ACOs and privatisation, future developments and concludes by providing support for the approach.

Using Hot Topics for searches

Recently I was asked to conduct a quick search to provide some information on Accountable Care Organisations and Accountable Care Systems.

Image Source:Love heart decorated cappuccino (milk coffe cocoa decoration).jpg by Yannick Bammert

Luckily I remembered the Hot Topics that we have been adding to the MAP over the past year. The hot topic about Accountable Care Organisations, provided a great starting point for the search highlighting some of the key reports and including a useful summary which I could use in my search report.

 

If you have any ideas for any new hot topics  to be added to the MAP, email us at map@libraryservices.nhs.uk 

 

Integrating care: contracting for accountable models by NHS England

A  Policy Briefing aimed at healthcare professionals is available for LKS staff to share in their own organisations. This has been produced and shared by the JET Library, Mid Cheshire Hospitals NHS Foundation Trust. Please feel free to reproduce it (with acknowledgement to JET Library) for your own purposes.

Impact on library policy/practice: 

Possible knowledge management opportunities whilst working with managers, commissioners, transformation teams and other healthcare leaders to support organisations and staff whilst undergoing these changes.

Current awareness / linking into other organisations and disseminating that information- condensing the amount of information available/ do once and share.

Source: NHS England

Link to main document

Publication format: PDF

Date of publication: August 2017

Summary of driver: 

The Five-Year Forward View and the Next Steps update published in March 2017 described a movement towards integrated care delivered through collaboration across health and care systems. It also introduced the concept of Multispecialty Community Providers (MCP) and Primary and Acute Care System (PACS) vanguards.

Key features of driver

• Sustainability and Transformation Programmes (STPs) are a way of facilitating this collaboration among local leaders and clinicians
• Eight areas are ready to go further and become Accountable Care Systems (ACSs) – they will have greater freedom and control over the operation of their local health system and how funding is deployed More ACSs will be added later as STPs mature
• Some areas also want to establish Accountable Care Organisations (ACOs). ACOs are where the commissioners in that area have a contract with a single organisation for the great majority of health and social-care services. This is a long and complex process and most places are looking to become ACSs first
• A few areas – particularly some of the Multispecialty Community Providers (MCP) and Primary and Acute Care System (PACS) vanguards – are on the road to establishing an ACO. An ACO model simplifies governance and decision making, brings together funding streams and allows a single provider organisation to make most decisions about how to allocate resources and design care for its local population.
• ACOs will need to demonstrate a number of features viz:
  • A focus on delivering concrete service improvements
  • A compelling vision of the benefits to be delivered
  • A robust and sustainable financial model
  • Consistency with STP/ACS plans for the future
  • High levels of engagement and support among health-and-social-care leaders
  • Sufficient commitment from primary-care providers
  • Robust system plans to commission, procure, fund, establish and oversee the ACO
  • Clear plans to identify, mitigate and manage risk
• Three main contractual approaches through with accountable models can be established in practice:
  • Virtual. Practices, local community service providers and commissioners enter into an “alliance agreement,” which would overlay existing commissioning contracts
  • Partially-integrated. Commissioners re-procure, under a single contract, all services that would be within the scope of a fully-integrated model except for core General Practice
  • Fully-integrated. Commissioners re-procure, under a single contract, all of the ‘in scope,’ services including core General Practice

Primary audience: Clinical commissioning groups, local community service providers and other commissioners, health and social care staff.

Date last updated: September 2017

Due for review: September 2018

Group member responsible: LK

Hot topic: Accountable Care Organisations

A Word version of this briefing aimed at health care professionals is available for LKS staff to share in their own organisations.  Please feel free to reproduce it (with acknowledgement) for your own purposes.

Impact on library policy/practice: 

• LKS teams may be affected by changes to organisational structures as a result of the emergence of Integrated Care Systems, Integrated Care Partnerships and Accountable Care Organisations (ACOs).
• There may be an opportunity to deliver evidence and knowledge to managers, commissioners and transformation teams as health care services undergo this change.
• As organisational boundaries blur and take a ‘whole population’ approach, LKS may be required to adapt their service delivery models accordingly.
• If healthcare moves away from a competitive structure and towards a collaborative one, there will be many opportunities relating to knowledge management that could support the sharing and dissemination of good practice, innovation and organisational knowledge.
• LKS will have to consider how the negotiation and procurement of resources needs to adapt to reflect the changes in organisational structures.
• There is a clear role for technology in supporting the emergence of these news systems that presents an opportunity for digitally enabled LKS.

What is an Accountable Care Organisation?

An Accountable Care Organisation (ACO) or Accountable Care System (ACS) brings together a number of providers (e.g. acute hospital care, general practice, mental health, social care, ambulance services and pharmacies) to take responsibility for the cost and quality of care for a defined population within an agreed budget (1).

ACOs have been proposed as one way of overcoming fragmented responsibility for the commissioning and provision of care in the NHS.  They could in principle offer an organisational structure that draws together previously siloed or competing providers into a network with a shared sense of purpose and financial interest (3).

Next Steps on the Five Year Forward View (5) describes ACOs as “an evolved version of an STP” and states that ACOs “provide joined up, better coordinated care”.  It published the names of nine geographical areas that are likely to emerge as ACOs in 2017/18.

What can we learn about ACOs from elsewhere?

ACOs have evolved recently in the United States and they build on a much longer history of integrated care systems such as Kaiser Permanente and Intermountain Healthcare (1).

In the UK, three ‘Vanguard’ schemes stated their intention to explore the potential of the ACO as an organising structure in the NHS: Northumbria, Northamptonshire and Salford (3).

The first wave of Integrated Care Systems (formerly shadow Accountable Care Organisations) are currently assuming accountability for local operational and financial performance in:  South Yorkshire and Bassetlaw, Frimley Health and Care, Dorset,  Bedfordshire, Luton and Milton Keynes, Nottinghamshire, Blackpool and Fylde Coast,
West Berkshire, Buckinghamshire, Greater Manchester (devolution deal), Surrey Heartlands (devolution deal) (8).

What are the challenges involved?

• Relationships: Establishing strong relationships between the leaders of participating organisations and the clinicians who deliver care;
• Technology: Accelerating the implementation of electronic care records to help predict avoidable hospital admissions and to coordinate discharge planning;
• Finance: New ways of commissioning and paying for services need to be established across traditional organisational boundaries (1).
• Legal challenge: The proposed  changes to regulations and consultation on the draft ACO contract have resulted in two legal challenges from 999 Call for
  the NHS and JR4NHS. (7)

Further reading

1. King’s Fund, 2016, Accountable Care Organisations explained
2. King’s Fund, 2014, Accountable Care Organisations in the United States and England
3. National Health Executive, 2016, Accountable care organisations: the future of the NHS?
4. Nuffield Trust, 2016, Accountable Care Organisations: The winners and losers
5. NHS England, 2017, Next Steps On The NHS Five Year Forward View
6. House of Commons (2018) Accountable Care Organisations
7. Kings Fund (2018) Making sense of integrated care systems, integrated care partnerships and accountable care organisations in the NHS in England
8. NHS England (2018) Integrated care systems (ICSs)

Primary audience: LKS staff and their wider organisations

Date last updated: February 2018

Due for review: May 2018

Group member responsible: VT