Shifting to accountable care: characteristics and capabilities

The NHS Five Year Forward View set out new models of care, including Primary and Acute Care Systems and Multispecialty Community Providers, drawing on international experience of accountable care provision. Examples such as the Alzira model demonstrate how transformative care models can deliver better outcomes at lower cost.

Download the Alzira Model here

Characteristics of accountable care provision

While accountable care provision can take a number of forms and can be applied in different ways,  we have identified a number of common characteristics:

  • Multiple organisations are involved in delivering health and care services 
  • A focus on integration and collaboration resulting in more multi-disciplinary working
  • Ability to manage and co-ordinate the care of individuals along the full length of clinical and social care pathways
  • Proactive management of population groups to inform early intervention and prevention
  • Integrated IT solutions to support collaboration and sharing of information
  • Treating and supporting patients in different, more appropriate, settings as a result of improved co-ordination and flexibility within the contracts
  • Increased involvement and engagement of patients and service users in the design, delivery and improvement of services

These characteristics have been enabled by commissioners and policy makers who have worked to establish the appropriate conditions to enable such provision. This shift is largely characterised by larger,  longer-term contract s with a shared set of outcomes and performance measures.

Capabilities of  accountable care provision: does your organisation have the capabilities it needs?

Experience from accountable care organisations operating across the world shows that the successful delivery of accountable care requires capability in 8 key areas:

  1. Strategy & vision: There is a compelling vision and clear strategy for managing and delivering clinical, patient and service user outcomes. This is shared by all organisations involved in the delivery of health and care.
  2. Leadership & governance: Excellent clinical and managerial leadership supported by robust governance to enable change and develop a culture of collaboration. Structures enabling effective delivery and shared decision-making.
  3. Processes: Clear processes are in place, enabling co-ordinated delivery and alignment across multiple organisations delivering health and care service. These ensure patient involvement, regulatory compliance and risk management.
  4. Technology: Technology and integrated systems are used to enable the delivery of outcomes and ensure that care is centred on the patient. Information is used to support and manage service improvement. 
  5. Performance management: Performance measurement, analysis, reporting and improvement processes are aligned across, and understood by all organisations delivering services.
  6. Financial and risk management: Appropriate financial and risk management controls are in place to identify and mange safety, reputational, demand and financial risks and mitigate them through early action and identification. There is an ability to identify the cost base along a whole health and social care pathway and/or population group as well as share risk and systems to manage payment allocations to organisations involved in delivering the contract.
  7. People and culture: Organisations are able to identify, recruit and retain an appropriately skilled and adaptable workforce. There is an ongoing commitment to workforce development and an emphasis on joint working that is supported by a culture of collaboration, quality and patient care.
  8. Sourcing and collaboration: Accountable care providers collaborate with a range of organisations and these relationships are managed and supported by robust agreements. Innovation and development runs across all organisations and different skills are drawn upon to inform decision-making.

PwC is creating a tool to give you a clear view about your organisation’s areas of strength and showing you where you need to develop capabilities in order to transition to accountable care provision. Contact Dan Burke to find out more.