Accountable care – the art of the possible

A seven step guide

What is accountable care and what is the difference between an ACO and ACS?

Accountable care is a model which brings together a variety of provider organisations, including primary care, to plan for and meet the care needs for a defined population within a set budget to an agreed level of quality. The difference between an ACS and an ACO is that in the former organisationally separate partners work together to integrate care and develop collective responsibility
for population health. Whereas it is envisaged that ACOs will be single organisations holding single contracts which are responsible for the planning and delivery of the majority of health and care services in an area.

The NHS continues to develop plans for population-based integrated health systems. ‘A seven step guide to accountable care’ which we co-produced with NHS Providers earlier this year addressed in brief how NHS organisations might respond to proposals for the evolution of Sustainability and Transformation Partnerships (STPs) into Accountable Care Systems (ACSs) and in
some areas eventually into Accountable Care Organisations (ACOs).

Since the publication of the guide, most STP areas have started to make progress with this initiative, albeit at different speeds. We have been continuing to work with clients in supporting them to develop accountable care models and we are pleased to announce the publication of an updated guide to coincide with the NHS Providers conference in November 2017.

The updated guide aims to demonstrate the ‘art of the possible’ by setting out the options and key issues within the existing legislative framework for organisations to think about as they take the first steps towards ACSs and ACOs.

The seven steps it covers are:

  • phasing – the need for a roadmap to guide organisations towards accountable care models and first steps that organisations should consider taking
  • partners – which organisations should and could be involved in an accountable care model, and how
  • governance – the importance of clarity on who is accountable and for robust decision-making mechanisms
  • contracting – options for contracting models for accountable care, including alliance contracting and the ACO contract
  • funding – the evolution towards population-based payment systems
  • organisational form – the pros and cons of different organisational forms to deliver an ACO
  • enablers – key enablers including technology, workforce and how to develop a shared culture.

Lessons from an NHS Providers roundtable

We were delighted to host a roundtable discussion about accountable care with senior representatives from a number of NHS provider members this summer. Key points discussed were:

  • integration of primary care with other health and care services may not be easy to achieve in the short term. GPs speaking with a united voice is important to engagement of primary care in an accountable care model
  • robust decision-making is essential to make sure organisations stick to the decisions they make
  • in reaching agreements some organisational altruism is likely to be necessary. Partners need to recognise that each of them may have to give up something for a new way of working to emerge
  • local context is everything – the model will inevitably need to be tailored to local geography, population, relationships and other factors
  • commissioning and provision are two sides of the same coin. Strategic commissioning must be looking to the longterm
  • a new payment and funding model is essential to make accountable care work
  • it must be made easier for staff to move around in the system – technology and information sharing are key
  • culture still trumps strategy, so having the development of a common culture in mind from the outset is important and it needs to be planned for and implemented.

For a copy of the guide please contact Jamie Foster at

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