Integrated Care Monitor
following news, publications and policies on ‘Accountable Care’ and ‘Integrated Care’ Systems, Organisations and Providers
- House of Commons Briefing Paper (July 2018) on Accountable Care Organisations Useful, factual and open summary of issues: of course Accountable Care Organisations have now been rebranded as "Integrated Care Organisations". However the Briefing does not really probe very deeply, or examine any actual plans. In fact ACOs were never accountable: neither are ICOs – and they are not actually integrated either. If you hated the old idea because it had an American name, you will probably hate the new one just as much -- or even more because it has all the same problems but an even sillier name.
- Health and Social Care Committee report - Integrated care: organisations, partnerships and systems, Seventh Report of Session 2017–19 Important update, flawed in some respects, most significantly in not consistently counterposing the actual disintegration and fragmentation of the NHS with contracting, continued commissioner-provider split and separation of NHS and (largely privatised and fragmented) social care on one hand, with the happy-clappy NHs England & CCG rhetoric of "integration" on the other. Useful concession to concerns includes recommendation: " The Department should publish an annual assessment of the extent of private sector in the NHS, including the value, number and percentage of contracts awarded to NHS, private providers, charities, social enterprises and community interest companies. This should include an analysis of historic trends in the extent of private sector involvement over a 5–10-year period. (Paragraph 184)"
- KONP statement on HEALTH AND SOCIAL CARE COMMITTEE REPORT ON INTEGRATED CARE Critique of a report which shies away from the evidence submitted on the real problems with "integrated care" and ACOs.
- Blog from Devon councillor lifts lid on plans to close community hospitals and use nursing homes Shock revelation at Health Scrutiny suggests the ‘new model of care’ is more about switching intermediate care from community hospitals to ‘block bookings’ in private nursing homes – saving costs and freeing up assets. How long will it last?
- Beyond Utilization: Reimagining Providers As Consumers To Promote Hospital Price Competition May 18 blog from US Health Affairs blog, arguing that ACOs "have yet to produce substantial cost savings and are unlikely to directly confront the fundamental problem of high prices." It suggests using competition as a way to force down prices -- but lacks any serious evidence that this could work for health care in the USA.
- "Integrated Care" in Liverpool A detailed and up to date analysis by Greg Dropkin of Liverpool KONP of the twists and turns of NHS England and Department policy shifts as reflected at local level.
- BMA January report 'Destination Integration' A series of quotes and thoughts from various people on the prospects for STPs, ACSs and other innovative models of care given the constraints of the 2012 Health & Social Care Act.
- Exchange of letters between Jeremy Hunt and Sarah Wollaston, chair of the Commons Health Committee Wollaston presses for, and Hunt agrees to delay the roll-out of ACOs pending public consultation and an inquiry by the committee.
- NHS England attempts to rebrand toxic "Accountable care Systems" as "Integrated care Systems" New planning guidance (p12) makes clear a desire to dodge away from the terminology that underlines the roots of "accountable care" in the US. But since the contracts and content remain unchanged, it seems this is a change in name only.
Coupled with the decision to hold a public consultation and delay introduction of new regulations to allow ACSs and ACOs, plus delays in some of the vanguard schemes, it seems that pressure from a suspicious and angry public, the JR4NHS judicial review, and the disquiet of Tory MPs including Health Committee Chair Sarah Wollaston have obliged ministers to delay progress for at least a few months.
- Second ACO contract delayed amid fears of 'unrealistic deadlines' Exclusive report from (£) HSJ on delay to £6bn Manchester contract.
- Creation of first ACOs put on pause (£) HSJ report by Rebecca Thomas (24 January) notes:
"NHS England and the Department of Health have effectively paused the creation of the first accountable care organisations, pending further consultation.
Health secretary Jeremy Hunt said the ACO contract - published by NHS England in draft last year - would not be put in place in any areas until after the national commissioning organisation holds a consultation in coming months.
He wrote to Commons health committee chair Sarah Wollaston on January 22, in response to a letter from her last week requesting that moves to implement ACOs be delayed pending a committee inquiry. "
- Liverpool letter to councillors on ACS Reject the Accountable Care System
- KONP Briefing Paper on ACOs and ACSs Detailed study by Jan Savage, adopted by Keep Our NHS Public in December 2017
- Are ACOs working? Experts disagree Varying assessments of the US version of ACOs, published by Kaiser Health News
- stps-and-the-fragmentation-of-the-english-nhs An interesting blog by former NHS Chief Executive Adrian Mercer.
- Contract Package: Questions and Answers (NHS England on Accountable Care Organisation (ACO) Contract package) Contains the key statement that:
“There will be no formal restrictions on who can hold the Contract. Both NHS bodies (e.g. a Foundation Trust) and non-NHS bodies (e.g. a GP Limited Liability Partnership) can bid to provide the ACO. Through the procurement process and the Integrated Support and Assurance Process (ISAP), providers will need to demonstrate to commissioners and to NHS England and NHS Improvement that they are capable of holding, and delivering, the contract.”
“The Public Contracts Regulations (PCR 2015) require that contracts for clinical services with a lifetime cost over the £589,148 threshold must be advertised to the market. This does not necessarily mean that there will always need to be a competitive tendering exercise before a contract can be awarded, but in any event commissioners are required to act fairly and transparently and treat all potential providers of the relevant services equally.”
- Integrating care: contracting for accountable models - NHS England
NHS England sum up ACSs: "An ACS is an evolved version of an STP, potentially covering a sub–set of an STP’s geography, in which commissioners and providers, in partnership with Local Authorities, take explicit collective responsibility for resources and population health." – August 2017
- The Economics of Medicare Accountable Care Organizations
Article based on US experience, completed October 2015, published 2016
- Developing accountable care systems Lessons from Canterbury, New Zealand
King's Fund 2017 study of an ACS with no market system, no acute service cuts or closures, and only marginal private sector role
- Capitation payment – international examples - compiled with McKinsey for Monitor
Intro states: 'As part of the development of payment approaches for Integrated Care, Monitor commissioned a review of some of the international examples of capitation payment'.
This research, supported by McKinsey & Company, has informed our thinking on how international models of care and payment approaches may hold relevant lessons for the NHS, ideas which we set out in our accompanying ‘Capitation: a potential new payment model to enable integrated care’.
NB the 'Integrated Care and Support Exchange (ICASE)' which was supposed to hold the supporting evidence and information has since been closed down and the links to it go nowhere.
- Vanguards – New Models of Care - Description of the 5 new models
List of and links to the various vanguard projects sponsored by NHS England
- Capitation: a potential new payment model to enable integrated care - 2014
2014 Monitor guidance that is supposed to keep track of private sector and other "independent" providers
- Optum brochure - Supporting the transition towards accountable care
Sales pitch to British ACSs from the subdivision of UnitedHealth that has profited hugely from providing "back office" and IT systems for Accountable Care Organisations in USA
- UNITEDHEALTH GROUP THIRD QUARTER HIGHLIGHTS - Press Release 2017
From the autumn of 2017, an insight in where the money is being made by Simon Stevens' former employers in the USA, seen by some as potential privatisers of the NHS
- Mills & Reeve Legal & Commercial update on new NHS England national model contract for ACOs
A briefing from a legal firm (August 2017) which does not mention any role for the private sector
- Special Purpose Vehicles (potentially private sector)
- Accountable Care Organizations and the Affordable Care Act – Huffington Post blog
- Accountable care organizations: Who are the winners and losers? Ashish Jha, MD, MPH
- Accountable Care Organizations In 2016: Private And Public-Sector Growth And Dispersion David Muhlestein and Mark McClellan
- ACO Winners and Losers: a quick take The blog of Ashish Jha
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