Commissioning and contracting for integrated care: Supporting better outcomes for patients

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This conference provided a valuable learning opportunity for organisations that are grappling with how to create more innovative contracting mechanisms to support greater efficiencies, accountability, provider collaboration, sharing of data and better outcomes for patients.

Highlights from this event

Chris Ham: Assessing the potential impact for innovative commissioning and contracting in the UK

Chris Ham, Chief Executive at The King's Fund, discusses the key questions which need to be answered when developing payment systems for integrated care. He considers a number of options and stresses the difficulty in finding the most effective system.

Watch Chris's presentation

Stephen Shortell: Accountable care organisations in the United States and England

Stephen Shortell, University of California, Berkley, explains how accountable care organisations (ACOs) work in the US and looks at the lessons that have been learnt so far.

Watch Stephen's presentation


Session one: International lessons

Welcome and introduction
Dr Nicola Walsh, Director, Integrated Care Programme, The King’s Fund

  • Lessons from ACOs in US: What have we learned so far?
    Steve Shortell, Blue Cross of California Distinguished Professor of Health Policy and Management and Professor of Organization Behavior, Haas School of Business, and Dean Emeritus, UC Berkeley, California
  • Assessing the potential impact for innovative commissioning and contracting in the UK
    Professor Chris Ham
    , Chief Executive, The King’s Fund

Session two: Case studies

Delegates chose to attend A or B and C.

A: Alliance Contracting

Chaired by Professor Chris Ham, Chief Executive, The King's Fund

  • Dr Linda Hutchinson, Director, LH Alliances
  • Robert Breedon, Partner, Wragge & Co

B: Prime Contractor Model

Chaired by Dr Nicola Walsh, Director, Integrated Care Programme, The King’s Fund

  • Dr Diane Bell, Director of Strategy and Services Redesign, NHS Bedfordshire Clinical Commissioning Group
  • Dr Alan Nye, GPSI Rheumatology/Director, Pennine Partnership MSK Ltd
  • Nick Boyle, Head of Business Development, Circle

C: Commissioning for Outcome Based Incentivized Contracts (COBICS)

Chaired by: Richard Murray, Director of Policy, The King’s Fund

  • Dr Nicholas Hicks, Founder Member of the COBIC programme and Chief Executive, Cobic Ltd
  • Dr Emma Stanton, Founder, Beacon UK
  • Jenny Palmer, Director from Beacon UK

Session three: UK Lessons

Welcome back
Professor Chris Ham, Chief Executive, The King's Fund

  • What are the risks and benefits of various contracting methods?
    Bob Ricketts CBE, Director of Commissioning Support Services Strategy & Market Development, NHS England
  • Supporting local health systems to deliver the right care in the right settings
    Catherine Pollard, Director of Pricing and Integrated Care, Monitor
    Ivy Wong, Interim Head of commissioning Policy and Resources, NHS England

Session four: Payment systems

Welcome back
Professor John Appleby, Chief Economist, The King's Fund

  • Future payments systems in local government: whole place budgets
    Carol Culley, Assistant Chief Executive (Finance and Performance), Manchester City Council
  • Future payment systems in the NHS: capitated budgets and other innovations 
    Richard Murray, Director of Policy, The King’s Fund
  • Development innovative payment schemes in a complex system: lessons from Singapore
    Jason Cheah, Chief Executive Officer, Agency for Integrated Care, Singapore


Dr Jason Cheah

Chief Executive Officer, Agency for Integrated Care, Singapore

Dr Jason Cheah graduated with a medical degree from the National University of Singapore in 1991. After completing the requisite clinical training and residency postings in general internal medicine, he was offered a scholarship and traineeship in Public Health Medicine. He successfully completed that training in 1998 and obtained his Masters of Medicine in Public Health (with Distinction) from the same University. He concurrently also completed his Masters in Health Care Management from Wales University (Swansea) and a MBA from Warwick University. In 2001, he was awarded the Fellowship of the Academy of Medicine (FAM) of Singapore.

Dr Cheah worked for 8 years in the Ministry of Health, Singapore, dealing with a variety of health policy and planning, health regulation and accreditation issues. He then spent a year in the private sector as the Assistant General Manager and then Acting General Manager of Gleneagles Hospital. In 2000, Dr Cheah returned to the public sector and started the Clinical Project Management and Planning Office in the National Healthcare Group (NHG). He was appointed as Chief Projects Officer (CPO) and also concurrently as Director of Clinical Services at Alexandra Hospital. In Nov 2005, Dr Cheah was appointed as Chief Executive Officer of the National Healthcare Group Polyclinics (NHGP).

In July 2009, Dr Cheah was appointed by the Ministry of Health Singapore as CEO of a new National Agency for Integrated Care (AIC). This Agency is charged with integrating care for the numerous patients with chronic medical conditions across the continuum from acute hospitals to community hospitals, nursing homes and home care.

Dr Cheah remains active in teaching in the Department of Epidemiology and Public Health in the Faculty of Medicine in the Yong Loo Lin (YLL) School of Medicine, National University of Singapore. He was the Chair of the Organising Committee of the 1st Asian Conference on Integrated Care held in Singapore in February 2011. He has also been a Member of the International Journal of Integrated Care (IJIC) Editorial Board since March 2011.

Dr Linda Hutchinson

Director, LH Alliances

Linda has a successful track record in innovation and delivery. A paediatrician with 25 years' experience, she has also led local and national improvement initiatives and programmes. Following consultant, university and NHS Trust Director posts, she joined the Office of the Strategic Health Authorities and was its Director for 16 months. As Director of Registration at the Care Quality Commission, she led the change programme that created the new regulatory model for health and social care.

Linda's company, LH Alliances Ltd, formed in 2011 to support commissioning and contracting approaches that create collaborative environments, in particular, alliance contracting. She led the development of the first alliance contract in health and social care in this country, in mental health services in Stockport and is currently working with a number of health and social care commissioners around the country.

Professor Stephen Shortell

Blue Cross of California Distinguished Professor of Health Policy and Management and Professor of Organization Behavior, Haas School of Business, and Dean Emeritus, UC Berkeley, California

Dr Shortell has served as Principal Investigator on NSPO1 and NSPO2. His particular expertise is in conceptualizing, measuring, and analyzing organizational factors that are associated with physician organization performance. His papers have appeared in a wide variety of organisational research and health services and health policy research journals and he is the author or co-author of ten books. Dr Shortell is an elected member of the Institute of Medicine and past editor of Health Services Research. He has been the recipient of the distinguished Baxter Allegiance Prize for his contributions to health services research, the Distinguished Investigator Award from Academy Health, and many other awards.

Robert Breedon

Partner, Wragge & Co

Robert is an experienced commercial lawyer with specialist experience in health care, having worked at the Department of Health from 2006 to 2011. Prior to that, he worked in private practice as well as in industry for both Southern Electric plc and The BOC Group plc. Robert was formerly the head of NHS Contracting, the team within the Department of Health responsible for the contract and performance management of a large number of clinical services contracts. A former insurance litigator, Robert has also provided commercial advice and support on a range of insurance and health-related matters. He is also a trained mediator and advocate of alternative dispute resolution. He is an enthusiast for the delivery of integrated care and the use of different contracting models and payment mechanisms, having contributed to a number of publications and articles.

Dr Diane Bell

Director of Strategy and Services Redesign, NHS Bedfordshire Clinical Commissioning Group

Dr Diane Bell joined the NHS Bedfordshire Clinical Commissioning Group in 2011 after a year as a Commonwealth Fund Harkness Fellow in the USA studying primary care physicians' perceptions of value and outcomes in three US health care systems. She originally trained and worked as a hospital physician then as a consultant in public health medicine and as Director of Strategy at NHS Milton Keynes PCT. Diane's interests are in the promotion of patient and clinical outcomes as a unifying concept that can encourage collaboration between providers and increase value in healthcare.

Dr Alan Nye

GPSI Rheumatology/Director, Pennine Partnership MSK Ltd

Alan qualified in Sheffield in 1983 and became a partner in a General Practice in Oldham in 1987, where he still works on a part-time basis.

After completing his diploma in rheumatology he became a GPSI in 2003 and led on the transfer of a hospital-based rheumatology service into an integrated clinical assessment and treatment service (ICATS) in 2006. He is now executive director of the ICATS - Pennine MSK Partnership Ltd, who provide rheumatology, orthopaedic and chronic pain services for Oldham with over 11,000 new patient referrals a year. Pennine MSK started a programme budget – prime contractor model of service delivery on 1st May 2011. They clinically lead the integrated commissioning of musculoskeletal pathways across primary, community and secondary care and have recently formed a joint venture with Circle and successfully bid for the Bedford MSK prime contractor contract.

Alan is also Clinical Lead at the Advancing Quality Alliance (AQuA). AQuA was commissioned to deliver the national programme around implementing shared decision making in the NHS in 2012. Recently they won a bid from the Health Foundation to look at shared decision making and self management in transition services, under their 'Closing the Gap' programme. Prior to this, Alan was Associate Medical Director at NHS Direct, clinically leading on the development of Patient Decision Aids for the NHS.

He is also a member of the clinical reference group for the co-operation and competition panel that is part of Monitor, a trustee for the Arthritis and Musculoskeletal Alliance and President of the Primary Care Rheumatology Society.

Dr Nicholas Hicks

Founder Member of the COBIC programme and Chief Executive, Cobic Ltd

Nick is a founder member of the COBIC programme and is Chief Executive of Cobic Ltd. He was previously Director of Public Health at Milton Keynes Primary Care Trust. His career has included 20 years as a clinician working in hospitals, general practice, the mental health service, and community health services, as a director of public health, consultant, a PCT chief executive, an academic and as a policy maker with several attachments in the Department of Health, including the Strategy Unit and most recently working with the NHS Commissioning Board.

Dr Emma Stanton

Founder, Beacon UK

Dr Emma Stanton combines her role as Chief Executive of Beacon UK with practicing psychiatry at South London and Maudsley NHS Foundation Trust.

From 2010-2011, Emma was a Commonwealth Fund Harkness Fellow in health care policy and practice and is now a senior associate at the Institute for Strategy and Competitiveness, at Harvard Business School in the United States, where she researched the value-based approach to health-care delivery. Emma holds an honorary senior lecturer position with University College London, is a former advisor to England’s Chief Medical Officer, Professor Sir Liam Donaldson and co-founded Diagnosis, a clinical leadership social enterprise. Recently nominated as one of HSJ’s most inspirational women in health and also one of the HSJ Top Innovators in the NHS, Emma holds an executive MBA from Imperial College, London, a MRCPsych from the Royal College of Psychiatrists and a BM from Southampton University. Emma’s publications include Clinical Leadership: Bridging the Divide (Quay Books, 2009) and MBA for Medics (Radcliffe, 2010).

Bob Ricketts CBE

Director of Commissioning Support Services Strategy & Market Development, NHS England

Bob Ricketts CBE, Director of Commissioning Support Services and Market Development for NHS England since September 2012. His work focuses on developing and implementing two core strategies for NHS England – developing commissioning support services (published in June) and creating autonomous NHS Commissioning Support Units (provisionally to be published in December).

The focus of Bob's previous director roles within the Department of Health included developing the NHS Standard Contract, competition policy, patient choice and choice of any qualified provider, the social enterprise sector, Transforming Community Services, and commissioning and demand-side reform. Prior to that he had more than 20 years' experience in senior management roles within the NHS.

Catherine Pollard

Director of Pricing and Integrated Care, Monitor

Catherine Pollard joined Monitor in February 2012 to lead their work on pricing development and integrated care. She is responsible for leading the research and development of Monitor’s plans to reshape the payment system for the NHS, as well as working with NHS England to produce the National Tariff. She is currently leading engagement on Monitor's strategy for the payment system, which was launched with the production of the joint Monitor-NHS England discussion paper, How can the payment system do more for patients? For the 2014/15 National Tariff she is responsible for the policy formulation that relate to rules for local price-setting, variations from national prices and best practice tariffs. Working closely with NHS England and other national partners, Catherine is also leading Monitor's efforts to fulfil its duty to enable integrated care. Monitor is a joint signatory to Integrated Care and Support: our shared commitment, which sets a clear direction on integrated care – what good person-centred, coordinated care looks and feels like and how we will work together to achieve it over the coming years.

Prior to joining Monitor, Catherine worked at Barts Health Trust, where she was the Service Integration Lead. In this role, she led work on the clinical integration of Tower Hamlets Community Health Services with the acute trust. This included establishing a Community Virtual Ward and redesigning pathways for long-term conditions, older people and end-of-life care, to improve patient outcomes and support cost improvement objectives. In addition to her work in health care, Catherine has worked as a management consultant in the public sector, working at McKinsey on economic and agricultural development strategies and with 2020 Delivery on issues relating to tertiary healthcare, offender management and asylum seeking.

Ivy Wong

Interim Head of commissioning Policy and Resources, NHS England

Ivy Wong, originally from Canada, has worked in the UK health service for five years, in various strategy and policy roles. Previously, she worked in the private sector in IT consulting, marketing and communications before pursuing a master's in public administration.  Her areas of interest are frailty, multimorbidity and payment systems for integrated care.

Richard Murray

Director of Policy, The King’s Fund

Click here to view Richard's biography

Carol Culley

Assistant Chief Executive (Finance and Performance), Manchester City Council

Carol Culley is Assistant Chief Executive for Finance and Performance at Manchester City Council. Carol joined Manchester from Oxfordshire in 2001. She started in Manchester as the Assistant Director for Finance for Social Care before moving to a more corporate role and then becomming Assistant Chief Executive. She has extensive experience of social care finance and has been heavily involved in the Greater Manchester work on Public Sector Reform including the community budget pilot work and the work on the integration of health and social care.

Carol has also worked closely with the LGA and ADASS to support their input into previous social care spending review processes. She is a member of the CIPFA Panel for Social Care and is a non-executive director of the Manchester Credit Union.

Nick Boyle

Head of Business Development, Circle

Nick leads on developing strategic partnerships with other independent healthcare organisations. He is also a general and laparoscopic surgeon and practices part-time in Maidstone and Tunbridge Wells in Kent. He was formerly Director of Surgery and lead clinician for upper gastrointestinal surgery at Maidstone and Tunbridge Wells NHS Trust. Nick trained in Southampton and at Guy's and St Thomas' hospitals in London, and holds a Master of Surgery from the University of London.