Accountable Care Organisations; the new model of care in the NHS?

This week the HSJ published a barometer survey, indicating the favoured contracting routes for clinical commissioning leaders.

Among those considered most popular were Accountable Care Systems (ACS) and alliance contracts, with 58% and 55% of commissioners respectively saying they expect to adopt this approach in the next 12-18 months. Fewer leaders, albeit still 26%, thought it likely they would establish an Accountable Care Organisation (ACO), again in the next 12-18 months.

That commissioners are considering alternative forms of integration and contracting should come as little surprise; but what do we know about these models of care? Moreover, how can commissioners ensure smooth implementation? Here we consider some of the key features of the ACO model.

ACOs, a model more familiar in the United States, are generally understood as a group of providers working together and assuming joint accountability for care of a specified population, with the target of improving quality and containing costs (HSJ 2016). From a financial standpoint, ACOs are often based on capitated budgets for a population, ensuring providers have a shared interest in managing the health economy.

As when implementing any new model of care there will be significant challenges. Central to the successful delivery of the ACO model of care is a Single Point of Access (SPA) or a care coordination centre, which can both coordinate services and track cost. The key, is of course, ensuring that patients are referred down the most clinically and financially effective pathway; typically involving the use of community services. Active case management is paramount, to ensure that patients with complex or long term health needs are systematically screened, assessed and monitored.

Having a robust IT solution in place is important when trying to implement any new model of care as they more often than not ‘require prompt co-ordination and transfer of information across providers, and the need to keep a close watch on patient outcomes and other measures of performance for which providers are held to account’ (King’s fund, 2015).

psHEALTH can work with commissioners, providers and ACOs to configure pathways, ensure communication among systems, and guarantee full visibility of a patient on their chosen pathway. Furthermore we provide comprehensive data, assisting you to measure outcomes, ultimately enabling the delivery of better outcomes at a lower cost.