Providing Accountable Care; comparing the delivery of Primary Care in the UK and USA through Accountable Care Systems and Organisations

The implementation of accountable care is at a very early stage in the UK, but NHS England is working on developing systems across several regions, based on new models, particularly the Primary Care Home. The US is further ahead, with Accountable Care Organisations, enshrined in legislation since 2010.

A two-day symposium held in Washington DC in May 2017 to compare and contrast key features of first contact primary care that could be translated between the health and care systems of the UK and USA, with the aim of publishing an in-depth follow-up report.

The symposium brought together health leaders from both countries to share best practice and exchange ideas and experience about accountable care.

Areas of consensus that emerged from the symposium were as follows:

  • Transitions from fee-for-service systems to integrated, capitated and accountable care will only be effective if coordinated by primary care.
  • For primary care-led systems to improve population health, interventions must build on the strengths of people and communities rather than targeting their weaknesses.
  • Caution is needed before transposing ACO models to the UK, since ACOs still have lessons to learn in terms of improved cost savings, better team-based care and more collaborative governance.
  • Effective implementation of accountable care in the UK will depend on improvements in population health analytics, new predictive and case management tools and fully electronic health records.
  • New commissioning and payment mechanisms will be needed, based on longerterm, outcome-based contracts and whole-population budgets.
  • Better coordination of care across the primary-secondary interface will require changes in culture, behaviour and leadership style, with an emphasis on team development and coaching.
  • Workforce capacity and capability, and both the numbers and skill mix of care professionals in relation to population size and need, are crucial factors in the success of accountable care.
  • There is a need for a consistent shared definition of accountable care and a clear understanding of the differences between the various models in use.

The report from the symposium can be viewed by clicking on the PDF button below.

Download Providing_Accountable_Care-1.pdf