ACOs and the like – will or won’t they save us from certain doom?

ACOs and the like – will or won’t they save us from certain doom 
This remains hot space in STP thoughts up and down the country

About 18 months ago I was asked by a FT chief exec “I’ve read about these ACO things, but what does the evidence really tell us and if we are going to do it, how” 
It was by far the hardest evidence review I ever had to do
I regularly get asked the same question. I think the evidence of impact has moved on a little bit – and I haven’t updated – but the basic building blocks are the same.

I can only apologise in advance for the length. It’s a complex question and required me to think quite hard about how to pull the evidence together, arrange it, contextualise it and set it out.
Attached is an introductory doc – the read me, and my set of slides I use from time to time.
Then there are the detailed files for each of the “chunks” of the answer.

In short my answer is
1. Should we – yes, what’s plan b
2. What does the evidence say wrt to cost and quality – early signs promising, too early to definitively tell, the Blue Cross Blue Shield Alternative Quality Contract is the best developed set of evidence. Many caveats and methodological issues in this evidence set
3. How – I’ve tried to set out what I think are the main paramaters. I was advised by Prof Mulley from Dartmouth to make sure that as we go down this path we DON’T over focus on the contract and organisational machinery but that we pay attention to narrative, communication and cultural issues – especially frontline. Obviously the former is mighty important. The latter – in his view (and remember all this was his idea) is probably more important.
4. This is NOT a panacea to quick wins and easy savings. It is an exercise in aligning incentives for population focused care and getting the incentives for cost, quality and outcomes in one place. Don’t think it will solve your problems tomorrow.

For your joy and delectation I dumped the material on the YH AHSN website, they kindly agreed to humour me. You may use it / abuse it / ignore it as you wish. 

The site is here:

http://www.yhahsn.org.uk/service/population-health-service/strategic-system-support/

The main chunks of my answer are
Introduction

http://www.yhahsn.org.uk/wp-content/uploads/2016/04/Into_Read_Me.pdf

Summary slides

http://www.yhahsn.org.uk/wp-content/uploads/2016/04/Greg-Fell-Presentation.pptx

Some thoughts on population size, scale and scope

http://www.yhahsn.org.uk/wp-content/uploads/2016/04/12.-GF-Thoughts-on-Scale-and-Scope.pdf

Key lessons from elsewhere in the world 

http://www.yhahsn.org.uk/wp-content/uploads/2016/04/10.-GF-Lessons-from-elsewhere-translated-to-England-.pdf

What does the evidence on impact actually tell us

http://www.yhahsn.org.uk/wp-content/uploads/2016/04/2.-GF-Evidence-what-they-conclude.pdf

Some thoughts on role of funder

http://www.yhahsn.org.uk/wp-content/uploads/2016/04/11.-GF-Role-of-Funder.pdf

Some considerations for providers

http://www.yhahsn.org.uk/wp-content/uploads/2016/04/8.-GF-Provider-Issues-and-Hospital-Collaboration.pdf

Governance, OD and regulatory issues

http://www.yhahsn.org.uk/wp-content/uploads/2016/04/9.-GF-Governance-regulatory-and-OD-issues.pdf
Contracting and commissioning considerations

http://www.yhahsn.org.uk/wp-content/uploads/2016/04/4.-GF-Contracting-Legal-issues.pdf
Quality and outcome metrics

http://www.yhahsn.org.uk/wp-content/uploads/2016/04/5.-GF-ACO-Performance-Metrics.pdf
Who should “lead” – hospital or GP

(Hint – neither)

http://www.yhahsn.org.uk/wp-content/uploads/2016/04/6.-GF-GP-or-hospital-lead.pdf

Cultural issues

http://www.yhahsn.org.uk/wp-content/uploads/2016/04/7.-GF-Culture-and-Accountable-Care.pdf

Some eg of the questions that have cropped up for me

http://www.yhahsn.org.uk/wp-content/uploads/2016/04/14.-GF-Key-points-and-FAQ.pdf

One or two thoughts on key investnets and return

https://yhahsn.webex.com/mw3000/wireless/meetinglist.do?siteurl=yhahsn&from=wireless&rnd=0.8943496155528321&TS=1466721140478&CookieSupported=true

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