Accountable Care Systems and the Spectre of Health Inequity

Equity vs Equality

In August this year NHS England published a paper titled ‘ACOs and the NHS commissioning system’ In it, NHSE described its vision for commissioning set within the context of Accountable Care Systems and Accountable Care Organisations. One of the most striking features of the document was the inclusion at the very beginning of an ‘Equality and health inequalities statement’.

The debate on health inequalities has been with us for decades. Less has been written on the subject of health inequity. The distinction between inequity and inequality is nuanced but worthy of note.

If Accountable Care Systems are serious about addressing the continuing problem of health inequity then for me there are at least two stand out actions: 1. Use data to gain insight. 2. Put primary care ‘front and centre’. Read More…

Accountable Care Systems: Betting the Farm on “Promise”?

Accountable Care Systems

Back in June this year, Simon Stevens announced the first eight Accountable Care Systems (ACS). NHS England are making some big bets on Accountable Care Systems being able to deliver on the ambitions of Sustainability and Transformation Partnerships (STPs).

Timely then that I remind myself of a conference I attended in San Diego last year where one of the speakers was Dr Linda Dunbar, Vice President, Population Health at The Johns Hopkins Community Partnership (J-CHiP). J-CHiP is an Accountable Care Organisation (ACO) offering a model of community based accountable care in Baltimore.

As far as this ACO in the US is concerned, there is no ‘silver bullet’, just a lot of hard work and a lot of focus on shifting the culture. Read More…

The ‘Promise’ of Accountable Care

US Flag

Last week I was in San Diego speaking at The Johns Hopkins University 2016 ACG® System International Conference. The conference attracted delegates from all over the world, including the US, Sweden, Italy, South Africa and the UK. In all cases, delegates and speakers were exercised with the challenge of delivering the ‘Triple Aim’: better health outcomes, better patient experience, reduced cost. Here’s what I learned. Read More…

Population Health Management — The Writing’s on the Wall

Writing on the wall population health management

The Health Service Journal (HSJ) reports that NHS England is currently working on a new commissioning strategy. Unsurprisingly references are made to an accountable care system and the role of CCGs within it. Place-based commissioning also gets a name-check. The Kings Fund will be pleased. Read More…

Population Health Management — All Together Now

Last week the ever excellent Kings Fund published a new report called ‘Place-based systems of care: A way forward for the NHS in England’. Within its pages there exist powerful arguments for why the ‘zero-sum game’ that characterises the current NHS (aka. The Purchaser/Provider divide) has had its day. The report pictures a future where NHS organisations are increasingly collaborating to manage the finite resources — people and money — available to them.

Unsurprisingly, Accountable Care Organisations (ACOs) get another name-check and a new world of commissioning is proposed in which commissioners — spanning wider geographies than at present — take on a strategic role for defining outcomes and measuring the performance of the health and social care system as a whole. Read More…

Data Transparency will make or break Accountable Care Organisations

Comet 67P / Churyumov-Gerasimenko

On 30th July the ever excellent Health Service Journal broke the story that Northumberland CCG was planning to hand budgets and functions to a provider led Accountable Care Organisation (ACO).

Whatever your view of the accountable care experience in the United States, this is a story that is anything but frivolous. As the HSJ highlighted, the move in Northumberland represents a big move away from the current commissioner/provider split. Read More…