STP, ACS or ACO? 1 OUR TRANSFORMATION PLANS AIM TO INTEGRATE CARE - - PowerPoint PPT Presentation

STP, ACS or ACO?

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OUR TRANSFORMATION PLANS AIM TO INTEGRATE CARE

Why is there a move toward accountable care?

• Our accountability structures do

not prioritise the triple aim we have set out in the Five Year Forward View

• Population health outcomes

(inequalities)

• Quality of care- (meeting

national standards and evidence based practice)

• Better value – (right care right

place, and reduced demand/productivity )

• We need to build a new system

management framework to encourage the right behaviours

• We need to build on our

partnerships

• Acting and behaving as one

system

• Innovating and improving

integration of care

– Between acute providers e.g hospital specialists working together to manage demand and meet workforce challenges- (maternity, mental health stroke, cancer…) – Primary care hubs working with wider community and acute services

• Developing governance for

planning, delivery, decision making, budget control

To become ACSs, STPs must take accountability for delivery in exchange for additional freedoms

Agree an accountable performance contract with NHS England and NHS Improvement; Commit to shared performance goals and a financial system ‘control total’; Create an effective collective decision making and governance structure; Demonstrate they are integrated; Deploy rigorous and validated population health management capabilities; Establish clear mechanisms for patient choice. In return, the NHS national bodies will offer: Delegated decision rights in respect

• f commissioning of primary care and

specialised services; A devolved transformation funding package; A single ‘one stop shop’ regulatory relationship with NHS England and NHS Improvement; The ability to redeploy attributable staff and related funding from NHS England and NHS Improvement to support the work of the ACS.

1 2 3 4 5 6 a b c d

STPs must be able to:

There may be structural consolidation within an STP or ACS in the form of “accountable

care organisations”

• An ACO is a provider organisation that is contractually responsible for providing an integrated set of

services to a defined population, supported by a single, integrated budget.

• The ACO can either provide services itself or sub-contract with others for those services.
• Multispecialty Community Providers (MCPs) and Primary and Acute Care System (PACS) are

examples of ACOs. Many of those furthest towards contracting for an ACO are vanguards.

• ACOs involve:

1) A single contract with longer contract length 2) A procurement process and contract assurance (ISAP) 3) A single, integrated budget (potentially with risk/ gain share with other providers) 4) A degree of outcomes based approach with the right controls in place 5) A potential change in how commissioning activities are carried out , as some of these are taken on by the ACO – though not a change to formal responsibilities.

• In a number of respects, the principles around governance, commissioning, payments, streamlined
• versight etc are similar for ACOs and ACSs.

Some illustrative configurations of Accountable Care Systems

ACS ACS

Acute

Community Primary Place 1 Place 2 Place 3

STP 2

Commissioner ACO

ACS

Acute

Community Primary Place 1 Place 2 Place 3

STP 4

ACO ACO ACO

ACS

Acute

Community Primary Place 1 Place 2 Place 3

STP 1

Acute Comm Hub Comm Hub Acute Comm Hub

ACS

Acute

Community Primary Place 1 Place 2 Place 3

STP 3

ACO

ACO (MCP)

ACO

Acute Commissioner

Or a wider Multi- STP System is also possible

Any questions?