1. What new care models may mean for accountability and commissioning Rachael Addicott, Senior Research Fellow r.addicott@kingsfund.org.uk @RachaelAddicott

2. Looking for new ideas Accountable Care Organisation Alliance ContractPrime Contract All focus on integrated delivery of care

3. International experience ›High performing integrated systems use capitated budgets for almost all care ›Main focus is on population based budgets not disease or condition based budgets ›They specify the quality/outcomes they expect to be delivered ›Systems are not over-reliant on payment methods and financial incentives – other tools are also important

5. Are we all talking about the same thing?

6. Experience of organising integrated care in England ›Purchaser provider split = contractual solutions ›Population health vs disease/population segment ›Scope and boundaries ›Defining a budget ›Cost shifting and risk shifting ›New competencies ›Supply chain management ›Collective governance and accountability

7. Collective accountability ›Reliance on informal influence ›Appeals to professional competitiveness ›Credibility of data ›Development and coaching – “learning opportunity” ›Financial penalties ›Removal from ACO network soft hard

8. Four things to remember… ›Engagement with providers, patients and wider communities ›Importance of both transactional and relational approaches ›Alignment of payment mechanisms and incentives ›Focus on building governance structures and processes