STP, ACS or ACO? 1
OUR TRANSFORMATION PLANS AIM TO INTEGRATE CARE
Why is there a move toward accountable care? • Our accountability structures do • We need to build on our not prioritise the triple aim we partnerships have set out in the Five Year • Acting and behaving as one Forward View system • Population health outcomes • Innovating and improving (inequalities) integration of care • Quality of care- (meeting – Between acute providers e.g national standards and evidence hospital specialists working together to manage demand and based practice) meet workforce challenges- • Better value – (right care right (maternity, mental health stroke, place, and reduced cancer…) demand/productivity ) – Primary care hubs working with wider community and acute services • We need to build a new system • Developing governance for management framework to planning, delivery, decision encourage the right behaviours making, budget control
To become ACSs, STPs must take accountability for delivery in exchange for additional freedoms STPs must be able to : In return, the NHS national bodies will offer: Agree an accountable performance 1 contract with NHS England and NHS Improvement; Delegated decision rights in respect a of commissioning of primary care and Commit to shared performance goals 2 specialised services; and a financial system ‘control total’; A devolved transformation funding b Create an effective collective decision 3 package; making and governance structure; A single ‘one stop shop’ regulatory c Demonstrate they are integrated; 4 relationship with NHS England and NHS Improvement; Deploy rigorous and validated population health management 5 The ability to redeploy attributable d capabilities; staff and related funding from NHS England and NHS Improvement to Establish clear mechanisms for patient 6 support the work of the ACS. choice.
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 oversight etc are similar for ACOs and ACSs.
Some illustrative configurations of Accountable Care Systems ACS ACS Acute Acute Acute Acute Comm Comm Comm Community ACO Community Hub Hub Hub Primary Primary Commissioner Commissioner Place 1 Place 2 Place 3 Place 1 Place 2 Place 3 Or a wider STP 2 STP 1 Multi- STP System is also possible ACS ACS ACS Acute Acute Acute ACO ACO Community Community ACO ACO ACO (PACS) (PACS) ACO (MCP) Primary Primary Commissioner Commissioner Commissioner Place 1 Place 2 Place 3 Place 1 Place 2 Place 3 STP 3 STP 4
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