1. Integrated Care Evidence Review Terms of Reference July 2013

2. Copyright ©2013 Integrating Care & the Local Government AssociationPage 2 Some key considerations for site selection:  There are clear cases of integrated care in the UK that demonstrate user experience, care outcomes and utilisation impact  Minimal whole system cost and financial data available for UK sites  Robust financial evidence for integrated care in the UK is limited to disease management models and services  Use of international case study with systematic financial evidence should be considered to develop value cases and toolkit  Not all sites will be able to demonstrate high quality of evidence – however, we are keen to prioritise practical planning and implementation examples Highlight from our evidence review so far:

3. Copyright ©2013 Integrating Care & the Local Government AssociationPage 3 Overall approach: Define review question and search criteria Sources include case studies submitted through workshops, advisors, specialists and existing Existing DH & LGA reviews Electronic searches Review Question 1 Develop overarching principles Searching Develop overarching principles 2 Searching (evidence long list) 2 June September Screen evidence and case studies based on evaluation criteria to id potential value cases Evidence include business cases, primary studies, grey and print sources, review of reviews Searching Screening (value case long list) 3 Input into value case and toolkit Synthesis of evidence and summary report Searching Develop overarching principles 2 Synthesis 4 In progress

4. Copyright ©2013 Integrating Care & the Local Government AssociationPage 4 Stage 1: The review question Search criteria: existing literature and case studies  health and well-being outcomes  individual experience  costs and efficiencies  lessons learned  planning & implementation tools mix of UK and international sites focus on system-wide examples Example components: risk stratification case management multi-disciplinary teams provider networks supported self-care improved information sharing care planning and co- ordination pooling arrangements personal budgets care trusts telehealth and telecare enablers ‘What is the evidence for improved outcomes from whole system integrated care’? How can local areas understand where there is a clear case for and learn from the implications of different approaches to whole system integrated care and supporting models? Example outcomes: user experience clinical outcomes utilisation of services financial impact: costs and savings

5. Copyright ©2013 Integrating Care & the Local Government AssociationPage 5 Stage 2: Searching – approach 1.Conducted thorough review of existing material to obtain an understanding of a)what can be achieved through integrated care; and b)what the preconditions for successful implementation of whole system integrated care are. 2.Collated list of components for successful whole system integrated care from literature review (e.g. population based approach, use of case coordinator etc.) 3.Considered sites that have excelled in at least one of the components and can demonstrate process and outcome indicators as well as experiential learning in this area. Self-care and prevention Population based approach Care coordination Multi-disciplinary care process, inc. single point of access Outcomes-based commissioning Common platform for information sharing New funding model e.g. capitated budgets Shared accountability and financial incentives whole system approach to person-centred, coordinated care Figure 1: Key components for successful whole system integrated care

6. Copyright ©2013 Integrating Care & the Local Government AssociationPage 6 Stage 2: Searching – potential evidence long list (1/2) LGA Proposed Sites (including pioneering sites, community based budgeting, care trusts) Greater Manchester Essex Kent Triborough Cheshire West and Chester Bournemouth, Poole and Dorset Staffordshire Birmingham South Devon and Torbay Swindon North Tyneside Cumbria Norfolk NE Lincolnshire Leeds South East London North East London Portsmouth and Southampton Lancashire Southend Herefordshire Newham Islington Cambridgeshire and Peterborough Wandsworth Wokingham Croydon Imperial Health Wiltshire Liverpool Sheffield Solihull Devon Greenwich Northumberland Birmingham Cornwall (telehealth) Isle of Wight Morecambe Bay Year of Care – Pilot Sites Calderdale & Kirklees North of Tyne Tower Hamlets 3 Million Lives - Pathfinders Worcestershire Merseyside North Yorkshire & Humber South Yorkshire & Bassetlaw Kernow, Cornwall & Scilly Kent & Medway Camden DALLAS sites End of Life Greenwich and Bexley Midhurst Macmillan service International LGA and DH Inputs (including workshops) International Sites Scotland – health and social care organisations Wales – Chronic Care Management demonstrators, “Radyr girls” Netherlands – Geriant: intensive neighbourhood based MDT teams Sweden – Norrtalje: intensive home based services Germany – Kinzigtal project – partner organisations Spain – Valencia Australia – HealthOne: Care planning and case management, Silver Chain: early discharge service New Zealand – Te Whringa Ora: education and supported self-care USA – Kaiser Permanente, Geisinger, Veterans Affairs, ChenMed, CareMore, Baylor Scott, John Hopkins Guided Care model, Thedacare Intermountain, HC Partners, Mayo Clinic, VHA, Camden C, Cleveland, Massachussets, PACE model, Care Transitions Programme – medium to large scale integration Canada – PRISMA – coordination of care between providers – GP led Alaska – the Southcentral Foundation NUKA model of care

7. Copyright ©2013 Integrating Care & the Local Government AssociationPage 7 Stage 2: Searching – potential evidence long list (2/2) Review of Reviews Integrated Care Models DH Review of Integrated Care Sites Bournemouth and Poole Cambridge Assura Church View, Sunderland North Cornwall Cumbria Durham Dales Nene (Northamptonshire Integrated Care Partnership) Newquay Norfolk North Tyneside Northumbria Principia, Nottinghamshire Tameside & Glossop Torbay Tower Hamlets Wakefield Nuffield Integration Report As above Kings Fund integrated care model Buckinghamshire Essex Isles of Scilly South Warwickshire North West London North Yorkshire Audit Commission Bristol North West England Southwark POPP Evaluation Bradford Brent Calderdale Camden Dorset East Sussex Leeds Luton North Lincolnshire Somerset Worcestershire Cochrane – collaboration between local health and local government agencies for health improvement – Hayes et al, 2012 Cardiff Copenhagen and Aarhus, Denmark Eindhoven, Netherlands Goteburg Jersey, UK Jerusalem Lewisham Lothian and Grampian New York Southern California Wrexham Co-creating Health Ayrshire and Arran Wandsworth NESTA - People Powered Health (PPH) – Business Case, 2013 Chelsea and Kensington Lambeth Newcastle Stockport Financial/Budget Model Scotland – Financial integration across health and social care: evidence review, 2010 Reduction in acute care usage Case Management – Huntley et al, 2013 ‘Grey’ & Print Search Social Impact Bonds Worcestershire ‘Maintaining Health’ Age UK Social Impact Bond Shared Lives (Lambeth, Leeds, Manchester and Newham) Bromley Healthcare ‘ExtraCare’ financing

8. Copyright ©2013 Integrating Care & the Local Government AssociationPage 8 Stage 3: Screening – evaluation criteria Evaluation criteria 1.0 Sustainability – maturity of case study site and evidence 2.1 Improved experience for service users 2.2 Improved clinical outcomes for service users 2.3 Clear financial model and savings 2.4 Articulated impact of model implementation and effects on utilisation of care 3.0 Practical experience – well articulated and transferable lessons learned Other screening considerations: Evidence quality, geography and socio-economic factors, scale of model, innovation Ratings Average: Good: Outstanding:

9. Copyright ©2013 Integrating Care & the Local Government AssociationPage 9 Stage 3: Potential sites for Value Cases UK Sites  Birmingham  Cornwall  Croydon  Cumbria  Essex  Greater Manchester  Greenwich  Herefordshire  Isle of Wight  Kent  Leeds  Liverpool  North East Lincolnshire  South Devon & Torbay  Triborough (London)  Wandsworth  Wiltshire Year of Care – Pilot Sites  Tower Hamlets 3 Million Lives – Pathfinders  Worcestershire International Sites  Wales – Chronic Conditions Management demonstrators  Germany – Kinzigtal project – partner organisations  New Zealand – Te Whiringa Ora (education and supported self-care)  USA – PACE model  USA (Alaska) – the Southcentral Foundation NUKA model of care THIS LIST IS NOT EXHAUSTIVE AND MAY BE ADDED TO