Many countries are turning to value based payment and accountable care models. Moving to a new model of care is not straightforward; having a clear plan that takes into account valuable lessons learned elsewhere will be vital.
Whilst different international health systems have different regulatory and legal systems, many face similar demographic and health care funding challenges. There is, for example, no straight forward answer to the conundrum of limited financial resources to accommodate an ageing population that has increasing health care needs.
In recent months, NHS England has renewed its new models of care and devolution programme and announced a fast track wave of eight accountable care systems (ACSs).
The ambition is to provide high quality care in the community, at home and in care homes; avoid unnecessary hospital admissions; shorten length of stay; enable patients to recover at home; and deliver longer term savings.
THE UK ACO OR ACS MODEL
Accountable care terminology originates in the United States, where accountable care organizations (ACOs) have grown in response to a need to control costs, reduce fragmentation and align incentives. There has been a long history of integrated care and delivery programmes in the United States, but changes in health care legislation provided key impetus to a growth in ACOs.
UK ACSs will have similar aims. They will be expected to integrate care between providers (primary, community, mental health and acute),likely using capitated or valued based payments with shared savings and risk. An ACS will have significant control over funding and will manage contractual relationships across a health system.
This all marks a major change, not least for providers, who have previously competed with each other with payments on a per service tariff. Some commentators have argued that, as in the United States, an ACS will need a statutory UK basis to achieve true success. The necessary change to NHS law, however, now looks unlikely given the amount of parliamentary time devoted to implementing Brexit. An ACS in the United Kingdom will therefore need to be set up within an existing system, using flexibilities where they exist. Valuable lessons can be learned from similar models in other countries.
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