As part of the “Making Accountable Care Happen” open course, Dr Katja Behrendt and Dr Manpreet Bains summarise key messages from Professor Shortell’s Keynote lecture on the promise, performance and future of accountable systems.
In October, the participants of the “Making Accountable Care Happen” open course at Imperial College Business School were given insights from Stephen Shortell, Professor of Public Health at University of California Berkeley. As a world leading expert in accountable care, he has carried out extensive research on the impact of strategic change in the health care sector. Professor Shortell compared the accountable care journey to that of tending a garden and provided some hints on how to nurture and grow roses, but avoid the thorns.
Professor Shortell presented evidence to date around the development of integrated delivery systems in the USA. He identified physician led organisations as more likely to succeed as accountable care organisations, particularly those led from the primary care side.
Asked whether it would be better to start with the whole population or a single disease group, he pointed out that population stratification/segmentation is a key activity to designing a successful accountable care system.
Another discussion explored the place of patients managing their own health and wellbeing, so systems can support individuals based on their needs. Professor Shortell referenced the use of the Patient Activation Measure as a key tool in this regard[i]. Understanding what’s important to patients and ensuring services are tailored accordingly was a recurring message.
What this means for the NHS
Professor Shortell is closely watching current policy and operational developments within the NHS, citing ongoing work in the Nottingham area as an example of good practice. He discussed how to achieve system redesign in smaller, well connected geographies whilst also acknowledging the need to work at scale across STP footprints. Despite admitting that many accountable care systems to date are small, he was positive about the possibilities to scale up, especially given the potential to spread investment in IT infrastructure.
A theme from the subsequent discussion was the importance of building a cohesive health and social care system, enabling a patient centric model of care. As a determinant of health, access to healthcare alone is estimated to contribute 20% to health outcomes[ii]. Other factors include health related behaviours (e.g. smoking, diet, exercise), social and economic factors (e.g. education, employment and income) and physical environment (e.g. housing and air quality). Building a well networked healthcare system that is able to influence these determinants of health through links to local government and social care, will be of vital importance for the future.
The “Making Accountable Care Happen” is a collaboration between ICHP, Optimedis-COBIC, The International Foundation of Integrated Care and Imperial College Business School. Find more information on our work in accountable care.
[i] NHS England – Patient Activation
[ii] The King’s Fund (2015) Inequalities in life expectancy.