1. 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

2. 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

3. 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

4. ‘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.’

7. 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

8. 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

9. Challenges

14. Means to an end

15. 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

16. 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 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

17. 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

18. 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

19. ‘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.’