Accountable care organisations in the United States and England: Testing, evaluating and learning what works

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The health system in England is facing a number of challenges including an ageing population, an increasing number of people with multiple, long-term conditions and a difficult financial climate. To meet these challenges, more integrated approaches to care delivery are needed to improve both the quality of care and patients' experience.

More people now need care across a number of different settings – hospitals, primary care, clinics, nursing homes and home care agencies – which are not co-ordinated, resulting in duplication of cost and effort and gaps in information and communication. In the United States, accountable care organisations (ACOs) – a group of providers that take responsibility for providing all the care for a given population for a specified period of time – have been developed to provide a more integrated approach to care.

Accountable care organisations in the United States and England describes the different types of ACOs emerging in the United States; presents some early evidence on their performance; assesses the future for ACOs; and discusses the implication of these developments for integrated care initiatives in England.

Comments

Angela Body

Position
Managing Director,
Organisation
4Health Home Care Agency
Comment date
13 January 2016
We are in the process of registering a cpmpany and we have chosen to use the ACO principles into our business case. Having already agreed on a he ethos of our service, it was a d light to read your paper.

Angela Body

Position
Managing Director,
Organisation
4Health Home Care Agency
Comment date
13 January 2016
We are in the process of registering a Federation that has Home Care agency with ACO principles and urlus income used to improve the care we will be providing. It was refreshing to read the Kings Fund report outlining the same philosophy.

Anthony Hockey

Position
Practice Manager,
Comment date
05 October 2016
Before the ACO is decided and who leads on this which in reality will be trust driven but we need primary care voice and involved at every stage. A couple of national problems certainly need addressing where the out dated use of HCA/Nurse support time for consultants which seems to a very old way of working having had a recent visit to the hospital for a potential back op I have had several appts when most of these could have been avoided. In primary care GPs have 10min appt and do not need a HCA or PN to sit in the room with them as we have comprehensive IT system. Another area to significantly reduce wasted funding is the laborious transfer of hospital letters and how many staff are involved in the process surely all letters can be sent to GP practices electronically and securely to practice mailboxes to avoid so much expense on data entry and repetition. Also the new services commissioned by CCGs/trusts can this involve primary care as their are some services which are not required or can be done much more differently.
I am all in favour of an ACO but primary care need to be involved in decision making at every stage.

Peter Lihou

Position
Managing Director,
Comment date
18 January 2018

Having read the Kings Fund article, I must protest about the continuing moves to replicate the failed American healthcare system in the UK.

We already have a system that works when funded and managed properly. Please don’t imagine we are duped into believing it’s failing due to anything other than the ideology of the present government.

No mention of the role of insurance companies or privatisation is made in your article but there are plenty of clues about the agenda. None of this requires anything other than a properly funded and well managed NHS - which is what we already have (or had) - except of course for the fact that selling more of it off provides greater profits for those who are already failing to deliver.

The language of your article says it all:

"First, they involve a provider or, more usually, an alliance of providers that collaborate to meet the needs of a defined population. Second, these providers take responsibility for a budget allocated by a commissioner or alliance of commissioners to deliver a range of services to that population. And third, ACOs work under a contract that specifies the outcomes and other objectives they are required to achieve within the given budget, often extending over a number of years.”

"Kaiser Permanente” - not a good example

"experience from health systems in the United States”

"United States” "United States” “United States"

"The relational challenges centre on the need to develop trust between the organisations and leaders involved as well as an ability to collaborate in a legal context that was designed to promote competition. “

We don’t need competition, further tiers of management, profit extracting companies with highly paid executives and shareholders, and we don’t need more acronyms.

Fund the NHS properly and stop abrogating responsibility.

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