This document outlines the concept of an Accountable Care Organisation (ACO) proposed for Cambridge, England. The ACO would be a partnership between primary and secondary care providers to deliver care within a fixed budget. It would integrate services across home, community centers, and hospitals using a shared electronic patient record. The ACO aims to improve outcomes while reducing costs through clinical and financial integration. It would take on financial risk for the population it serves and be accountable to the NHS for outcomes. The document discusses potential advantages, priorities, and structure of the proposed ACO.
3. Our Vision
Partnership between primary and secondary
care providers to deliver the best possible
clinical outcomes within a fixed budget
Clinical teams moving seamlessly from home to community
centre to hospital
Shared electronic patient record with patient access
Financial alignment and risk sharing of a capitated budget
Transforming academic excellence and research into on-the-
ground achievements for our population
4. Standard care model
Expertise
Location
Home General Practice Local Hospital Tertiary Centre
5. Doing less of the same
“A man with a hammer
sees a lot of things
worth hammering”
Attr. Mark Twain
“Insanity is doing the
same thing, over and
over again, but
expecting different
results"
Attr. Albert Einstein
6. What can we learn from 1782?
Thomas Whitcombe 1763-1824
8. Accountable Care Model
A single provider organisation crossing
primary/secondary care boundaries
Commissioned by NHS; accountable for outcomes
Registered primary care population
Capitated whole population budget
Financial risk held on provider side
9. Breaking of the Line
Expertise
Location
Home Health Centre DGH Tertiary Hospital
10. Proposed ACO Structure
A Community Interest Company run for the benefit of
the community, working in and with the community
Jointly owned by primary and secondary care
Board-level representation of patients, local authority
& both primary and secondary care clinicians
Accountable to commissioners for outcomes, not
processes
11. The Integrated Care Model
Clinical
Governance:
Goals,
Targets,
Pathways
Mx
Annual Plan
Annual
Pharma- Assessment Practice
ceuticals Credentialing
Patient Education.
The person
T2 Education with P/N and GP
Primary Care
diabetes/ Structured
Education
Education
T2 Ongoing self care
Education
Other interval Practice Visits
T1 Education visits
Clinic Visits
T1 Ongoing
Education
Practitioner
credentialing
Carer
Education
Information Management
Clinical data Audit/ Population
sharing feedback Monitoring
D Simmons
12. ACO Advantages
Alignment of financial interests
Clinical integration across primary/secondary chasm
Allows flexible use of human and financial resources
Based around single shared electronic patient record
Reduced transactional costs and bureaucracy
13. ACO Priorities
Living within a finite budget
Relentless focus on quality of care, safety,
outcomes, patient experience and careful use of
resources
Flexibility around service provision
Local accountability and shared decision making
14. Commissioner Benefits
Simple commissioning structure
Top-level outcomes specified, not micromanagement
of individual service specifications
Capitated budget – transparent, fair and open
Financial risk sits with provider, not commissioner
15. System Benefits
Reduced waste, inefficiencies and transactional costs
Shared records
Better data for research, audit and outcome measures
Better patient outcomes
Setting the standard by which others are judged
16. Our Vision – Patient Services
Local easy access to quality-assured health care
Extended opening of primary care facilities. Full
range of diagnostics provided at local level.
Ability to manage most conditions on-site, using
specialist knowledge when needed
Rapid access to specialist opinion using shared
record
17. Competition
ACO will, as a provider, have the ability to build or buy
services
ACO will purchase from other providers including NHS,
independent and third sectors, where it is best use of
resources and clinically appropriate
If ACO model delivers on quality and value then it sets
benchmark for other providers
Growth/consolidation may occur but openness about
system and structure will permit others to emulate design
and compete
18. Scale
Need to start small and be fleet of foot
Risk sharing arrangements with phased adoption of
higher risk areas as size of organisation increases
Risk from additional activity and random events mitigated
by movement from PBR (price) to true marginal cost and
shared ownership between primary and secondary care
Growth by success
19. Risks
Death by committee
Regulatory, political and economic environments
Delay
Compromise of purpose
Financial Failure
20. Making it happen
Conceptual buy-in from primary and secondary care
Permission to innovate
Design of evaluation and reporting
Identify resources to get going
Agreement to commission (CCG)
21. Will it fly?
“... Must ensure that we keep our current focus on
practice engagement and referral management to
give us the best chance of breaking even at the end
of the year...”
“...We are not clear how your proposed model would
contribute in resolving this problem.”
Local Commissioning Group, August 2011
22. Our difficulty lies not so much in developing new ideas
as in escaping from the old ones
John Maynard Keynes
1883-1946