A Word version of this briefing aimed at health care professionals is available for LKS staff to share in their own organisations.  Please feel free to reproduce it (with acknowledgement) for your own purposes.

Impact on library policy/practice: 

• LKS teams may be affected by changes to organisational structures as a result of the emergence of Integrated Care Systems, Integrated Care Partnerships and Accountable Care Organisations (ACOs).
• There may be an opportunity to deliver evidence and knowledge to managers, commissioners and transformation teams as health care services undergo this change.
• As organisational boundaries blur and take a ‘whole population’ approach, LKS may be required to adapt their service delivery models accordingly.
• If healthcare moves away from a competitive structure and towards a collaborative one, there will be many opportunities relating to knowledge management that could support the sharing and dissemination of good practice, innovation and organisational knowledge.
• LKS will have to consider how the negotiation and procurement of resources needs to adapt to reflect the changes in organisational structures.
• There is a clear role for technology in supporting the emergence of these news systems that presents an opportunity for digitally enabled LKS.

What is an Accountable Care Organisation?

An Accountable Care Organisation (ACO) or Accountable Care System (ACS) brings together a number of providers (e.g. acute hospital care, general practice, mental health, social care, ambulance services and pharmacies) to take responsibility for the cost and quality of care for a defined population within an agreed budget (1).

ACOs have been proposed as one way of overcoming fragmented responsibility for the commissioning and provision of care in the NHS.  They could in principle offer an organisational structure that draws together previously siloed or competing providers into a network with a shared sense of purpose and financial interest (3).

Next Steps on the Five Year Forward View (5) describes ACOs as “an evolved version of an STP” and states that ACOs “provide joined up, better coordinated care”.  It published the names of nine geographical areas that are likely to emerge as ACOs in 2017/18.

What can we learn about ACOs from elsewhere?

ACOs have evolved recently in the United States and they build on a much longer history of integrated care systems such as Kaiser Permanente and Intermountain Healthcare (1).

In the UK, three ‘Vanguard’ schemes stated their intention to explore the potential of the ACO as an organising structure in the NHS: Northumbria, Northamptonshire and Salford (3).

The first wave of Integrated Care Systems (formerly shadow Accountable Care Organisations) are currently assuming accountability for local operational and financial performance in:  South Yorkshire and Bassetlaw, Frimley Health and Care, Dorset,  Bedfordshire, Luton and Milton Keynes, Nottinghamshire, Blackpool and Fylde Coast,
West Berkshire, Buckinghamshire, Greater Manchester (devolution deal), Surrey Heartlands (devolution deal) (8).

What are the challenges involved?

• Relationships: Establishing strong relationships between the leaders of participating organisations and the clinicians who deliver care;
• Technology: Accelerating the implementation of electronic care records to help predict avoidable hospital admissions and to coordinate discharge planning;
• Finance: New ways of commissioning and paying for services need to be established across traditional organisational boundaries (1).
• Legal challenge: The proposed  changes to regulations and consultation on the draft ACO contract have resulted in two legal challenges from 999 Call for
  the NHS and JR4NHS. (7)

Further reading

1. King’s Fund, 2016, Accountable Care Organisations explained
2. King’s Fund, 2014, Accountable Care Organisations in the United States and England
3. National Health Executive, 2016, Accountable care organisations: the future of the NHS?
4. Nuffield Trust, 2016, Accountable Care Organisations: The winners and losers
5. NHS England, 2017, Next Steps On The NHS Five Year Forward View
6. House of Commons (2018) Accountable Care Organisations
7. Kings Fund (2018) Making sense of integrated care systems, integrated care partnerships and accountable care organisations in the NHS in England
8. NHS England (2018) Integrated care systems (ICSs)

Primary audience: LKS staff and their wider organisations

Date last updated: February 2018

Due for review: May 2018

Group member responsible: VT

Tagged: Accountable Care Organisation, Hot topics, STPs