Comment

02.10.17

NHS pricing: driving new care models

Source: NHE Sep/Oct 17

Monique Duffy-Brogan, chief pricing officer at NHS Improvement (NHSI), on the details of a new handbook designed to support accountable care organisations (ACOs) in creating new payment models.

At the moment, most patients face a fragmented system. Traditional divisions between primary, community, acute and social care can lead to services acting in an uncoordinated way, not centred on the needs of the patient. Existing ways of paying for services may not support greater integration or encourage activity taking place in the most appropriate setting. 

The payment system has a key role to play in delivering more integrated and patient-centred care. Since the publication of the Five Year Forward View in 2014, NHSI has been working with NHS England to ensure that payment can help enable system transformation by developing payment mechanisms to support new care models. 

Last month, as part of the ACO contract and support documents, NHSI and NHS England published ‘Whole population models of provision: Establishing integrated budgets’. This handbook provides detailed guidance on how to construct a population-based payment model for ACOs. 

The payment approach has been developed to encourage the promotion of whole-population management, prevention, self-care and a focus on outcomes rather than inputs. The intended scope for the integrated budget is the whole population, but it should also allow local areas flexibility of service scope to account for different care models, tailored to local needs. 

The payment approach: 

  • Covers the relevant service scope for the whole population (i.e. the registered list of patients and those in the locality of the care model not registered with GPs, rather than a segment of the population)
  • Removes the direct relationship between activity and payment
  • Improves alignment of payment for all providers within the care model
  • Better incentivises prevention and wellbeing
  • Focuses on management of outcomes, activity and costs across the system 

It’s important to stress that the payment approach and guidance have been co-developed with sites which have been developing integrated budgets for their own care models. They provided valuable insights into the challenges of implementing new payment models for ACOs, as well as highlighting where further guidance is needed. As a result, we are working to develop a gain/loss sharing implementation framework package for sites receiving intensive support. 

As the healthcare sector develops, it’s important to ensure that it has access to the right guidance and tools to help develop its own payment models. NHSI and NHS England will continue working to ensure that the payment system enables the delivery of new care models. For example, we are currently developing payment approaches for three accountable care systems (ACSs) – Greater Manchester, West Berkshire and Frimley Health – and sharing lessons with others developing their own ACS. We’re also considering what formal guidance we can co-develop in this area.

The development of the handbook and guidance on the payment approach is iterative. As ACO contracts start to go live, we will update it with the latest learnings and case studies. In the meantime, we’d welcome any feedback on what is or isn’t working, and what further guidance or practical examples would be helpful. 

Input from the sector was vital for developing the initial handbook. It will continue to be important for the sector’s collective learning and improvement, as the healthcare landscape continues to evolve.

FOR MORE INFORMATION

W: www.improvement.nhs.uk

W: www.tinyurl.com/NHE-ACO-Handbook

Comments

There are no comments. Why not be the first?

Add your comment

 

national health executive tv

more videos >

latest healthcare news

BMA calls for further investment, innovation into mental health

13/08/2020BMA calls for further investment, innovation into mental health

As coronavirus and the restrictions and measures which were taken to counteract it put an increased strain on people’s mental health, the B... more >
Work underway on £14.5m specialist CAMHS unit in Leeds

13/08/2020Work underway on £14.5m specialist CAMHS unit in Leeds

Work on a new state-of-the-art £14.5m Child and Adolescent Mental Health Service (CAMHS) unit, being built in partnerships between Leeds Co... more >
Consistent UK-wide methodology set to record Covid-19 deaths

13/08/2020Consistent UK-wide methodology set to record Covid-19 deaths

Following a review by Public Health England (PHE) into the methodology used to calculate the number of Covid-19 deaths in the UK, a new single, c... more >

the scalpel's daily blog

Calling the NHS a ‘Covid-only service’ is untrue, unfair and potentially dangerous

12/08/2020Calling the NHS a ‘Covid-only service’ is untrue, unfair and potentially dangerous

Chris Hopson, Chief Executive, NHS Providers Last week the NHS was widely described as providing a ‘Covid-19 only’ service for much of the last few months. Frontline NHS trust leaders are frustrated and disappointed at this description as it is untrue, unfair and potentially dangerous. It is untrue because local hospital leaders were only formally required to pause non-urgent services for a period of two weeks, between ... more >
read more blog posts from 'the scalpel' >

interviews

Matt Hancock says GP recruitment is on the rise to support ‘bedrock of the NHS’

24/10/2019Matt Hancock says GP recruitment is on the rise to support ‘bedrock of the NHS’

Today, speaking at the Royal College of General Practitioners (RCGP) annual conference, Matt Hancock highlighted what he believes to be the three... more >
NHS dreams come true for Teesside domestic

17/09/2019NHS dreams come true for Teesside domestic

Over 20 years ago, a Teesside hospital cleaner put down her mop and took steps towards her midwifery dreams. Lisa Payne has been delivering ... more >
How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

24/10/2018How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

A dedicated national social care service could be a potential solution to surging demand burdening acute health providers over the winter months,... more >
RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

24/10/2018RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

The president of the Royal College of Physicians (RCP) has told NHE that the college’s new headquarters based in Liverpool will become a hu... more >

last word

Haseeb Ahmad: ‘We all have a role to play in getting innovations quicker’

Haseeb Ahmad: ‘We all have a role to play in getting innovations quicker’

Haseeb Ahmad, president of the Association of the British Pharmaceutical Industry (ABPI), sits down with National Health Executive as part of our Last Word Q&A series. Would you talk us th... more > more last word articles >

editor's comment

26/06/2020Adapting and Innovating

Matt Roberts, National Health Executive Editorial Lead. NHE May/June 2020 Edition We’ve been through so much as a health sector and a society in recent months with coronavirus and nothing can take away from the loss and difficulties that we’ve faced but it vital we also don’t disregard the amazing efforts we’v... read more >

health service focus

‘We are the NHS’: NHS England publish newest People Plan

30/07/2020‘We are the NHS’: NHS England publish newest People Plan

NHS England has published its People Plan for... more >
How NHS Property Services adapted to a new way of working

01/07/2020How NHS Property Services adapted to a new way of working

From May/June 2020 edition Trish Stephen... more >