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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

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