The road to accountable care Bradford District and Craven – our system vision To create a sustainable health and care economy that supports people to be healthy, well and independent The road to accountable care

Joint Integrated working between health and social care The journey so far 2011 2013 2014 2015 2016 Health and social care partners in Bradford and Airedale signed off the Project Initiation Document for integrated care for adults Programme Our first HWB strategy made firm these commitments Learning from integrated working testing out new ways of commissioning and delivering better integrated care through population segmentation Introduction of Vanguard and Phase two of Pioneer Programme to support integration developments Work to develop place / population based health models i.e. accountable care systems ‘Accelerate’ to offer specialist support Over several years Bradford District and Craven health and care partners have been working together to ensure high quality care for the local population that is sustainable. This has been through the delivery of various transformation programmes and initiates. Joint Integrated working between health and social care

Why did we decide accountable care was the solution to our problem? Population health outcomes and inequalities drove this decision ……..a step up from just an integrated organisation

‘If you do what you always did, you will get what you always got.’ And……. Failed to achieve the level of integration we aspire to Shifts responsibility for care design to those who know best (providers and patients/service users) Creates an environment where commissioners can commission for population health not spend time trying to organise delivery of services Commissioning and payment systems perpetuate fragmentation Dominant, hospital-based, paternalistic illness model Professional and organisational silos Communities not engaged and their assets not used Organisations individually regulated and no-one is held to account for performance of the system ‘If you do what you always did, you will get what you always got.’

Right care, right place, first time Accountable Care: principles and characteristics Right care, right place, first time Triple aim: population health, experience of care and cost control through per capita cost approach Collective accountability for whole population health Triple integration - delivery across health & social care, community & acute, physical & mental health* Holistic care: whole life and whole person The person is an active participant, at the centre of their care Responsive, accessible, coordinated and simple Outcome-based strategic `joint’ commissioning enabling providers to collectively deliver outcomes (doing it together) Payment mechanisms that enable this Capitated budgets (£ per head of defined population) Harnessing individual and community assets

Evidence was pretty compelling Measure Alzira’s (Valencia, Spain) achievements (source: PWC) What this could achieve in Bradford Potential savings Cost per capita (acute care) 27% decrease Current: £663 per capita, per annum Future: £484 per capita, per annum £107.4m Hospital readmissions 34% reduction Current: 5447 Future: 3596 £3.6m A&E waiting times 54% reduction Current: 165 mins Future: 75 mins Quality improvement Average length of stay 20% reduction Current: 3.02 Future: 2.42 Dependent on speciality and cost of care Average elective wait 55% reduction Current: 70 days Future: 31 days

Challenges

Means to an end

Organisation or System No change to individual organisations statutory or legal decision making and governance Exploring how to make population health based decisions within existing arrangements through collaborative agreements, delegated decisions, partnerships, memorandum of understanding, formal contracts, new payment mechanisms

Airedale, Wharfedale & Craven Bradford Airedale, Wharfedale & Craven Structured collaboration to agree a new integrated model of care for diabetes prevention and treatment for implementation during 17/18. Working to achieve an Alliance Agreement (commissioner and provider partners) during 2017.....nearly there Formation of a Bradford Accountable Care Board to lead and oversee progress towards a new system. Structured collaboration for an Out of Hospital integrated health and social care model for adults with complex care needs with the intention to agree one contract by April 2018. Delivery of our other transformational programmes – Self-care & Prevention, Planned Care, Urgent & Emergency Care – each contributing to the sustainability of the broader system. Aiming for a total population coverage of accountable care by 2021. National and international research and learning to explore existing models through Pioneer Programme Testing the commissioning of new models of care through a range of initiatives focused on specific cohorts e.g. Enhanced Care / Complex Care / Integrated Community Services /Integrated Diabetes Considerable work underway to understand the size of the potential budget for commissioning population based care through a single contract. A system wide vision for accountable care approved Jointly agreed the roadmap that identifies the high activities required to move the current health and care system to the desired system as described in the vision Established a new ‘accountable care programme’ as a vehicle for delivery of the vision supported by a joint governance structure 2017 Development 2018 Shadow Running 2019 Contract Go Live AWC Timeline

Inter-dependencies District wide strategies aligned to the development of the accountable care system of operating.... Mental wellbeing strategy Transforming care for people with learning disabilities and/or autism Early years/early help programme Self care and prevention programmes

Not the only show in town WY programmes, Bradford and Airedale Programmes Acute Provider Collaboration Accountable Care Airedale, Wharfedale and Craven Accountable Care Bradford Built on strong communities and a solid foundation of voluntary, primary, and community services Self care and prevention Aligned to the Councils’ strategies

‘If you do what you always did, you will get what you always got.’ Next up...... Population health management strategy and approach New models of delivery – greater clarity Alignment and interdependency ‘If you do what you always did, you will get what you always got.’