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WELCOME
Wednesday 4 February 2015 Webinar
The Organisation of Integrated Care
The Organisation of Integrated Care:Encouraging collaboration through contractual
mechanisms
Wednesday 4 February 2015
1pm – 1.45pm
Dr Rachael AddicottSenior Research Fellow, The Kings Fund
&
Beverley MatthewsLTC Programme Lead, NHS Improving Quality
Beverley Matthews
LTC Programme LeadNHS Improving Quality
www.england.nhs.uk
LTC Year of Care Commissioning
Programme:
4
• 5 Early Implementer sites
• 35 Fast Followers
• Whole Population Datasets
• Implementation Guide
• Simulation Modelling
• Specialist Support Team
www.england.nhs.uk
LTC Framework Improvement
Programme:
5
Organisational &
Clinical
Processes
Informed and
engaged patients
and carers
Health & Care
Professionals
committed to
partnership
working
Commissioning
• Information and
technology
• Case finding & risk
stratification
• Care Planning
• Safety and
Experience
• Guidelines,
evidence and
national audits
• Care Delivery
• Self Management
• Information and
Technology
• Group and Peer
Support
• Care Planning
• Policies for carers
• Voluntary sector
patient & carer
support
• HSC Integration
• Multi Disciplinary
Teams
• Culture
• Workforce
• Technology
• Care Co-
ordination
• Care Planning
• Needs
Assessment and
Planning
• Joint
Commissioning
• Metrics and
Evaluation
• Service User and
Public Involvement
• Contracting and
Procurement
• Care Planning
• Tools and Levers
The table below sets out some of the key components needed to deliver the central
aim for LTC Framework - Person Centred Coordinated Care
Long Term Conditions Dashboardhttp://ccgtools.england.nhs.uk/ltcdashboard/flash/atlas.html
Long Term Conditions House of Care Toolkitwww.nhsiq.nhs.uk/improvement-programmes/long-term-conditions-and-integrated-care/house-of-care.aspx
Simulation Modelhttp://www.simul8.com/viewer/download.htm
#LTCyearofcare #LTCimprovement @NHSIQ
Tools and Resources:
www.england.nhs.uk
LTC Learning Community:
7
• Lunch & Learn Webinar Series
• Bite Size Master Classes
• Case Studies and Exemplars
• Twitter Chats
• Google Hangouts
To register email [email protected]
Date Webinar Hosted by Bev Matthews &
25 February @ 1pm NHS Commissioning AssemblyTechnology Enabled Resource for Commissioners
Annie ThompsonNHS England
4 March 2015 Primary Care Workforce in the 21st Century
Sharon LeeQueens Nurse, Primary Care Workforce Facilitator, South Kent Coast CCG
To be confirmed SIMUL8/ Simulation Tool Fionuala BonnarYear of Care Programme ManagerPublic Health, Kent County CouncilKent Early Implement Sites (LTC Year of Care Commissioning)
LTC Lunch & Learn Series
….coming soon…
The Organisation of Integrated Care: encouraging collaboration through contractual mechanisms
• Understand the features of three different contractual models, including their advantages and challenges of each.
• Be aware of the underlying principles of contracting for integrated care, and be able to consider contract terms that courage collaboration.
• Appreciate and plan for the commitment, resources and responsibilities involved in contracting for integrated care.
of Care foundation.
Learning Outcomes
for today’s Lunch & Learn
THE ORGANISATION OF INTEGRATED CARE:
Encouraging Collaboration through Contractual Mechanisms
Rachael Addicott
Context for change
› Quality improvement and cost containment
› Failures where patients fall through the gaps
› Limitations to informal collaboration
› Barriers to care coordination / disease management
› Fragmented payment system
› Information systems
New contracting models
› Accountable Care Organisations
› United States
› Prime contractor / prime provider
› Back-to-work programs in Australia and the United States
› Alliance contracting
› Australian construction industry
› New Zealand health care
All focus on integrated delivery of care
Staffordshire Bedfordshire Cambridgeshire Lambeth Salford
Focus of
contract
Cancer and end of life care (separate procurements)
Musculoskeletal care Older people and adult community services
Integrated personal support (mental health rehabilitation)
Older people
Contract type Prime contract (integrator)
Prime contract (integrator)
Prime provider contract Alliance contract Alliance contract
Main partners
in contract
development
• Local health commissioners
• NHS England (cancer only)
• Public Health England
• Macmillan Cancer Support
• Local health commissioners
• Circle (independent sector provider) appointed as prime contractor
• Local health commissioners
• Local health commissioners
• Local authority (responsible for social care)
Provider alliance:• Voluntary sector
providers• Mental health
hospital• Adult social care
• Alliance:• Local health
commissioners• Local authority• Acute hospital• Mental health
hospital
• GP provider consortium is an ‘honorary’ member
Motivation
for change
• Fragmentation• Poor access,
outcomes and patient experience
• Fragmentation• Value for money• Access problems• Variable expenditure
and quality of care
• Population growth• Constrained finances• Fragmentation of
existing pathways and provision
• Desire to focus on outcomes rather than activity
• To improve quality of care
• Manage costs• Overcome
limitations of informal collaboration
• Overcome limitations of informal collaboration
• Population growth
Estimated
contract value
£1.2 billion (approx. £120 million per year)
£169 million (approx. £27 million per year)
£800 million (£160m in the first year)
£24 million (£8 million per year)
Approx £700 million (£98 million in the first year)
Length of
contract
10 years 5 years 5 years (option of additional 2 years)
2 years (option of additional 1 year)
3½ years (option of additional 3 years)
Underlying principles of organisational integration
› Outcomes
› Service integration
› Aligned payment mechanisms
Ongoing challenges
› Political sensitivities
› New competencies – supply chain management; procurement
› Time and resources
› Sources of support and guidance
› Scope and boundaries:
› Cost shifting and risk shifting
› Defining a budget
Four points to remember…
› Engagement with providers, patients and wider communities
› Importance of both transactional and relational approaches
› Alignment of payment mechanisms and incentives
› Focus on building governance structures and processes
More information
› Alternative guide to the NHS:http://www.kingsfund.org.uk/projects/nhs-65/alternative-guide-new-nhs-england
› Accountable Care Organisations in the United States and England:http://www.kingsfund.org.uk/publications/accountable-care-organisations-united-states-and-england
› Commissioning and contracting for integrated care:http://www.kingsfund.org.uk/publications/commissioning-contracting-integrated-care
The Organisation of Integrated Care: encouraging collaboration through contractual mechanisms
• Understand the features of three different contractual models, including their advantages and challenges of each.
• Be aware of the underlying principles of contracting for integrated care, and be able to consider contract terms that courage collaboration.
• Appreciate and plan for the commitment, resources and responsibilities involved in contracting for integrated care.
of Care foundation.
Disscussion:
To register email [email protected]
LTC Lunch & Learn Series ….coming soon…
Date Webinar Hosted by Bev Matthews &
25 February @ 1pm NHS Commissioning AssemblyTechnology Enabled Resource for Commissioners
Annie ThompsonNHS England
4 March 2015 Primary Care Workforce in the 21st Century
Sharon LeeQueens Nurse, Primary Care Workforce Facilitator, South Kent Coast CCG
To be confirmed SIMUL8/ Simulation Tool Fionuala BonnarYear of Care Programme ManagerPublic Health, Kent County Council
