The aim of the conference was to highlight some examples where people are successfully implementing new care models with great impact on both quality and cost, reports Claire Read
As a group of senior healthcare leaders gathered to discuss making new care models a reality, HSJ editor Alastair McLellan suggested the stakes could scarcely be higher. With NHS cost pressures building and no foreseeable source of sufficient increased funding, “something has to give,” Mr McLellan told delegates at an exclusive HSJ/McKinsey Summit held earlier this month.
“Either that is a negative something; some form of rationing – so we had eyes and teeth, big changes in the history of the NHS when the dial turned and the money got too tight,” he said.
“Either something negative happens like that or the people in this room and colleagues across the country succeed in delivering something really significant in terms of new models of care.”
Penny Dash, senior partner at McKinsey and Company, emphasised neither the challenges nor the proposed solutions are exclusive to the NHS.
“We see exactly the same issues in France, Sweden, Germany, Australia, Singapore, the US, Canada. Equally, there’s a lot of consensus about the solutions, and in particular about what some of the care delivery models are that could support higher quality care delivered in a more cost effective way.”
While common themes quickly emerge – the need for strong leadership, common IT systems and changes to financial flows chief among them – there is no one size fits all solution
Her colleague Sorcha McKenna said this means there is good practice on which the NHS can draw. “One of the questions we often get asked [about new care models] is: how do I actually make it happen? Can you show me some examples of where people are doing this successfully? And the good news is there are a number of examples of where people are successfully implementing new care models with great impact on both quality and cost.”
The aim of the conference was to highlight some of those examples, with speakers from within England and beyond describing their work to fundamentally change healthcare delivery.
Uniting in diversity
Ms McKenna was keen to emphasise that while common themes quickly emerge – the need for strong leadership, common IT systems and changes to financial flows chief among them – there is no one size fits all solution.
“We broadly see three different ways people are coming together to deliver changing care models. The first is scaling up and reforming out of hospital provision. The second is in standardisation and consolidation in the acute sector: we see emerging hospital chains here in the UK already, and they are very common in the rest of the world as well.
”And we also see integrated providers, which provide care right the way across the care spectrum from the acute through to primary care.”
The uniting theme is the need for scale, she added. “If you look at the literature, and there are literally thousands of articles on integrated care and new delivery models, quite a lot of it will say there’s mixed results in terms of impact on hospital use and costs.
Work therefore began to fundamentally change the basis on which it was remunerated – from volume to value-based
”But we’ve done a meta-analysis of all of the articles around this, and what it shows is that if you implement new care models and if you do it at scale, then you really can have a dramatic impact on quality, outcomes and costs.”
The experience of a US accountable care organisation bore this out. Its chief operating officer told delegates how, in the mid-nineties, there had been the realisation the organisation would not be financially sustainable without dramatic change.
Work therefore began to fundamentally change the basis on which it was remunerated – from volume to value-based.
Initially, this accountable care setup covered 18,000 members of the local population. Today almost half a million lives are covered, and financial performance and patient outcomes are among the best in the country.
“It’s not easy, but we’ve figured out over the years how to take a large complex patient group that’s extremely needy and figure out how to do more with less,” the chief operating officer told delegates.
Part of that has involved integration, shifting care closer to home, and other themes which are front and centre in the Five Year Forward View. Equally critical has been risk stratification.
“We take every patient [covered by the ACO] and they all go into the wide part of a funnel. There’s then a lot of data mining and then based on an algorithm we’ve been revising over time, we come out with a small number of patients who get intensive, high touch care, others who get medium touch – but everyone gets some touch.
“We identify and prioritise: enrolling people into different programmes and pathways. We assess need, develop care plans, and then monitor and update.”
Many speakers from the new care model vanguards said they were heavily focusing on better stratification of their patients. Paul Mears, chief executive at Yeovil District Hospital NHS Foundation Trust, explained research had shown four per cent of his local population were consuming 50 per cent of the health and social care resources.
We identify and prioritise: enrolling people into different programmes and pathways
The South Somerset Symphony Project – one of the primary and acute care systems (PACS) vanguards – is aiming to change that, by introducing extensivist doctors who are solely responsible for caring for this group.
“I’m a great believer that the NHS is great, but it does have a bit of a one size fits all solution for everybody,” argued Mr Mears. “What we’ve decided is that actually that group of patients at the very, very top of the triangle, that 4,500, need a different type of service.”
Arriving at checkpoints
In listening to talk of the value of segmenting patient groups in new care models, Mr McLellan said he was reminded of similar conversations at conferences at the beginning of the 2000s.
“I used to hear a lot about identifying those most intensive users of hospital services,” he said in during a question and answer session with Dr Dash. “So what has changed this time?”
“We could say it has taken 14 years to get to the point of doing something about it, but for me the optimistic view is we are now getting to it,” Dr Dash responded.
“I think we’ve got to the point now where I sense that most clinical commissioning groups and a lot of GPs absolutely recognise they cannot carry on as they are.”
Again, it was a reminder of the high stakes when it comes to implementing new ways of caring for patients – and why drawing on learning of those who have already been on the journey will be so critical.