Accountable Care Systems Andrew Bland SPG, 26th January 2018 - - PowerPoint PPT Presentation

Accountable Care Systems

Andrew Bland SPG, 26th January 2018

There are 8 national ACS pilots - none in London at present This is not a new thing. The NHS and LAs in SEL have already begun pursuing greater integration of health and care systems, this work is intended to build upon and ensure coherence around the work already being done at a local level

What is meant by accountable care?

 Organisations in an area delivering better health and care outcomes by managing the total budget to maximise the health and care of whole populations  There is no specific model for accountable care delivery, though common characteristics include: – A focus on managing the health of the local population to improve prevention and self care – A focus on organisations working together to common aims – A contract with the right incentives, often using outcomes-based performance management – Effective links between hospitals, community, GPs, commissioners, local government and other stakeholders

What is not meant by accountable care?

 Accountable care is not an attempt to open up the NHS to large scale privatisation, or to limit the range of care that the NHS offers  It is not a top-down process driven by the SEL STP

Development of Accountable (Integrated) Care

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1.4 Development of Integrated Care Proposals

Following an initial expression of interest, in December 2017 the STP submitted an application to NHS England to be part of the second wave of ACS pilots. ACS pilots receive resources and support to help them develop. After careful consideration with STP partners, an application was developed and framed to reflect the following:

• A lot of good local work is already going on with integrated care in SEL, and we see the next phase as building from the bottom

up on this, but putting a consistent framework around a very complex group of systems;

• The building block of our approach would be the borough, but we recognise the need to work at sub-borough and multi-

borough level, as appropriate, to create a system of systems;

• We would potentially be the example of the complex London system, and be expected to share our learning with other similar

areas;

• We would see our approach as being different to the wave 1 pilot, where areas had to sign up to an MOU that tied them into

accelerated financial and performance improvement. Instead we see our involvement focusing on making more secure the financial and delivery plans we have already set out in the STP within each borough;

• We are very mindful of the need for a comprehensive stakeholder engagement programme to run alongside any submission,

and we are conscious of the sensitivity to the “Accountable Care” term.

Development of Integrated Care Proposals

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SLaM is the key MH provider for Lambeth, Southwark and Lewisham

SEL STP map

South East London is a complicated system, with a diverse population served by many different and overlapping organisations - only a third of provider income comes from SEL CCGs

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In a pure accountable care model, an entire health and care system for a population is managed as one; however the complexities of the SEL context means a different approach will be required

Commissioning responsibility for population segments sits at a different scale depending on size of population Commissioning responsibility for populations remains local, but some services for some populations are commissioned ‘jointly’ across a broader scale 1

Borough (LCP) Multi borough (CBP) SEL SEL + Pop’n 1 Pop’n 2 Pop’n 3 Pop’n 4 The SEL population is understood and therefore segmented into population groups, and a decision is made for each regarding what scale is required to manage that population effectively Accountability for commissioning and provision for these populations is then held at whatever scale is deemed appropriate

Commissioning Provision Commissioning Provision Commissioning Provision Commissioning Provision

Services (illustrative, not exhaustive)

Prevention Primary Social MH Sec’ry Comm

Accountability for local services remains within boroughs. Some services for are understood to be best delivered across a greater scale, and for these borough level (or organisations that provide services to borough level populations) look to collaborate to enable provision across a broader geography Borough (LCP) Multi borough (CBP) SEL SEL + All pop’n

Commissioning Provision

Services (illustrative, not exhaustive)

Prevention Primary Social MH Sec’ry Comm MH Sec’ry MH Sec’ry MH Sec’ry Prevention Prevention Prevention

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 This is difficult to implement in the current SEL context ̶ Maintaining a local focus would require accountability to sit below the SEL level for a large proportion of activity, but at this scale there are many

• rganisations without

coterminous boundaries  An alternative, favoured model is for commissioning accountability to remain in LCPs (i.e. within boroughs), but for the commissioning and provision of some specific services to take place across a broader scale ̶ Crucially, pathway design still needs to involve all partners

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Accountable Care: Development of Integrated Care Networks in Bromley Angela Bhan, Chief Officer, Bromley CCG SPG, 26th January 2018

Proactive Care: The Pathway

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An initial HOLISTIC ASSESSMENT (Guided conversation) is carried out with the patient by the most relevant person, who will usually be the Community Matron An INTEGRATED CARE AND SUPPORT PLAN will be developed by the Community Matron with the patient, supported by the CARE NAVIGATOR role (when required) A MULTI-DISCIPLINARY TEAM carries out an initial review of the person, updates and ratifies the INTEGRATED CARE PLAN, and assigns a CLINICAL LEAD based on the agreed PRIMARY NEED of each person The NOMINATED GP CHAIR chairs the MDT meetings to ensure all the patient’s needs are considered and actioned, ensuring that the best interests of the patient are considered and prioritised The updated INTEGRATED CARE AND SUPPORT PLAN is shared with the patient by the most relevant person and the care plan is implemented,

• verseen by the CLINICAL

LEAD and coordinated by the CARE NAVIGATOR with support from the MDT LIAISON COORDINATOR The MDT LIAISON / CARE NAVIGATOR arrange MDT reviews at the intervals set out in the INTEGRATED CARE AND SUPPORT PLAN to review the care plan progress and make changes to the patient's care as required (70% of patients will require discussion at a 2nd MDT) When required an HOLISTIC ASSESSMENT (guided conversation) is carried out to re-assess the needs of the person, and where appropriate reduce the intensity of support they need

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INITIAL ASSESSMENT INTEGRATED CARE PLAN INITIAL MDT MEETING RE-ASSESSMENT REGULAR REVIEW PATIENT INVOLVEMENT CLINICAL GOVERNANCE The CLINICAL LEAD is the first point of contact for the patient for their PRIMARY NEED, supported by the MDT LIAISON COORDINATOR who will be the main point of contact for all other needs (including self-management support)

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POINT OF CONTACT

INTEGRATED CARE PLAN

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Early Outcomes

1. 52% had no emergency admissions before or after the MDT, so assuming correct category of patient identified, these admissions were potentially avoided 2. Nearly 30% had emergency admissions before, but none or a reduced number after the MDT 3. A similar (nearly 30%) proportion had reduced or no planned admissions after the MDT 4. Nearly 20% of patients needed a care package in place (from not having any), or an increase in care package after the MDT 5. Nearly 5% of patients needed a reduction or no package of care after the MDT (if they had had something previously)

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Where next?

Health Innovation Network (HIN) commissioned to undertake an Initial evaluation, which showed good patient and professional

• feedback. Early outcomes are positive in terms of admission

avoidance and use of health, social care and third sector services. 1. Layer other pathways onto the ICNs, work commenced on heart failure and respiratory 2. Social care fully engaged, use of BCF to support increased input 3. Ongoing evaluation 4. Further development of Bromley Third Sector Enterprise 5. Evolution into an accountable care partnership

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South London Mental Health and Community Partnership (SLP)

Dr Matthew Patrick CEO, South London and Maudsley NHS Foundation Trust

SPG, 26th January 2017

In 2015, three leading mental health trusts in south London formed a hospital group, the first of its kind in London, bringing together the clinical expertise of thousands of NHS staff to identify areas of best practice to share across south London to improve patient care. Achievements to date

• New models of care (Forensics and CAMHS)
• Clinical workforce development with new roles
• Reduction in variation across services and pathways
• Leveraging procurement opportunities
• Standardising pharmacy practice
• Shared services for better productivity

South London Mental Health and Community Partnership: Overview

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Speaking over 200 languages

Total SWL population

3.2 million

12 London Boroughs, 2 STPs, 12 CCGS and 31 Members of Parliament 91 different nationalities and communities

9 hospitals With a combined resource of: £796m income

10,300 staff

South London Mental Health and Community Partnership: Facts and figures

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Mental Health Accountable Care System: Key enablers

Key considerations in developing accountable care models include:

• A relentless focus on improve quality and safety
• Ensuring governance is sufficient to get stuff done but not burdensome
• Strategies for developing a shared workforce with the right skills, values,

behaviours and culture

• Informatics: harnessing technology and innovation to improve patient

access to care, including by ensuring accountable care partners operate under single or aligned systems

• Strategies for accessing a shared estate and, in time, developing a fit for

purpose estate across each local economy

• Ensuring the contracting approaches are fit for purpose

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Partnership Board

Integrated functions Specialist Services

A model for a Mental Health Accountable Care System

Borough Based local care partnerships with commissioning capabilities

Borough Based local care partnerships with commissioning capabilities

Borough Based local care partnerships with commissioning capabilities

Borough Based local care partnerships with commissioning capabilities

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Local mental health services Community Based Physical Healthcare General practice

GP Mental Health Social Care Community Based Care Housing Voluntary Sector

New Primary Care

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