An Accountable care system is a system of healthcare provision which is intended to be integrated, and in particular to merge the funding of primary care with that for hospital care, therefore providing incentives to keep people healthy and out of hospital. It has features in common with Accountable care organizations.
Video Accountable care system
England
Accountable care systems are organisations in the English NHS which in some respects are intended to replicate the features of the American Accountable care organization. They are defined by NHS England as an area 'in which commissioners and providers, in partnership with local authorities, take explicit collective responsibility for resources and population health'.
Eight Sustainability and transformation plan areas were named by Simon Stevens in June 2017 as a first wave in the development of these systems. He said they "will bring together providers and commissioners to help break down barriers between primary, secondary and social care". They will be given up to £450 million between them in transformation funding over the next 4 years:
- Frimley Health. Frimley Health and Care System a consortium of 30 public and private care providers with five Clinical Commissioning Groups, five GP Federations, 10 Local, District and County Authorities, two Ambulance trusts and five mental health and community providers including Virgin Care;
- South Yorkshire and Bassetlaw, seven NHS hospital trusts - covering 15 hospital sites, which employ 45,000 staff and service 2.3 million residents;
- Nottinghamshire, with an initial focus on Greater Nottingham and the southern part of the sustainability and transformation partnership. The Greater Nottingham Transformation Partnership includes seven public bodies and Circle Health;
- Blackpool and Fylde Coast, with the potential to spread to other parts of the Lancashire and South Cumbria STP at a later stage;
- Dorset;
- Luton, with Milton Keynes and Bedfordshire;
- West Berkshire;
- Buckinghamshire.
Greater Manchester was not included because it already had more advanced arrangements under its "devolution" deal
In each area a provider or, more usually, an alliance of providers will collaborate to meet the needs of a defined population with a budget determined by capitation. There will be a contract that specifies the outcomes and other objectives they are required to achieve within the given budget over a period of time. This may extend well beyond health and social care services to encompass public health and other services. In Manchester the objectives are specified over ten years. Keeping people out of hospital by moving services into the community is a common feature. NHS trusts, Clinical Commissioning Groups and local authorities in the new ACSs will 'take on clear collective responsibility for resources and population health'.
The process was denounced by John Sinnott, Chief Executive of Leicestershire County Council in September 2017 as lacking any element of public accountability. He said that existing models in other countries were interesting but not relevant to democratic accountabilities in the UK since they had different governance structures and forms of service provision.
It is proposed that systems employing general practitioners would have to meet the costs of their indemnity insurance.
In September 2017 NHS England produced a handbook designed to support the creation of new payment models which are intended to remove the direct relationship between NHS activity and payment, improve the alignment of payment for all providers within the care model and better incentivise prevention and wellbeing.
In February 2018 it was announced that these organisations were in future to be called integrated care systems, and that all the 44 Sustainability and transformation plans will be expected to progress in this direction.
Maps Accountable care system
New Zealand
Canterbury, New Zealand has developed an accountable care system which has been held up as an example in the UK. Canterbury District Health Board has what is regarded as a successful system which has moderated the rate of growth in hospital use by investing in services in the community.
According to the King's Fund there were three key ingredients in the success of this system, which took several years to develop were:
- A clear, unifying vision behind the 'one system, one budget' message
- Sustained investment supporting staff with skills to innovate
- Development of new models of integrated working and new forms of contracting
The system has moderated demand for hospital care, particularly among older people, with lower acute medical admission rates compared with other parts of New Zealand and lower acute readmission rates, a shorter average length of stay with lower emergency department attendances, higher spending on community-based services and lower spending on emergency hospital care. However the number of hospital beds has not been reduced and the system struggles to meet demand.
Spain
Alzira, Valencia has a capitation based system with integration between primary and secondary care providers and a unified IT system across all services. This has become known as the Alzira model and received a great deal of attention. Under this model the provider receives a fixed annual sum per local inhabitant (capitation) from the regional government for the duration of the contract, and in return, must offer free, universal access to a range of primary, acute and specialist health services to the local population. It required a unified information system across all the services, with a shared patient record between GPs and specialists. In Alzira patients were free to go elsewhere for care, and if they did so the local provider had to meet the cost.
The quality of services appears to be considerably higher than other health care systems, with more day surgery, lower emergency admission rates, lower re-admission rates and higher patient satisfaction.
References
Source of the article : Wikipedia
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