Opinion

Accountable Care Organisations – the future of healthcare?

Amy Schofield 16 May 2017

 

Webinar report: Parallel Learning’s third webinar looks at the evolution of ACOs and the significant challenges they face.  

The third Parallel Learning webinar was another highly engaging affair. This time, we explored Accountable Care Organisations (ACOs), a number of which are under active development in areas of England. The speaker was David Thorne – Pf Magazine columnist and Programme Director, York Care Collaborative – and the webinar was, once again, expertly chaired by facilitator and management consultant Michael Sobanja.

 

What are ACOs?

The basic principles of ACOs are about organisations coming together to deliver health, and possibly some social care, in response to growing financial and service pressures. ACOs will be tasked with putting new care models in place that integrate services which were previously provided separately, bringing together a number of providers to take responsibility for the cost and quality of care for a defined population within an agreed budget. The idea for ACOs came about when NHS chief Simon Stevens visited the U.S. and was inspired by examples of how such organisations are working over there.

Currently, only one licensed ACO exists, in Northumberland. “There are aspirant ones forming, but this is leading edge stuff, and the cement is still very wet,” said David. ACOs currently remain a concept rather than a concrete structure.

 

Radical change

David presented the audience with an overview of the current state of the NHS, and how the uncertainty of the present is ushering in significant change for the future of both the health service and the pharma industry. “The NHS is going through radical change and we’re seeing a reversal in policy. The last time we went through this [due to changes under Andrew Lansley], there was a long period of preparation. This is a different kind of time, where we’re seeing change led by the new models of care; by innovation and people pushing the boundaries,” David explained.

He went on to clarify what this means for pharma. “When I meet people from pharma in the field, they’re urgently searching for some kind of organogram of what their future NHS is going to look like,” he said. “I’m afraid that you need to work with uncertainty – but what we are going to see is all kinds of new people, roles, patient pathways and new ways of doing things. This will really affect value proposition in your day–to–day work.”

 

Integration and partnership

NHS and industry know that the health service is not currently integrated. David explained: “There are transaction points, complex pathways; all kinds of strange handovers between different organisations”.

ACOs will be aiming to address this by integrating ‘one team’ principles. “The key thing from all these models is integration and partnership,” he said.

“We’re on a burning platform, and we have to do something different – probably quite radical,” David warned. “The NHS needs to control its supply and demand. The only way it can grasp these nettles is to work in a collaborative and integrative way. There’s is only one direction – integration.”

 

Impact for pharma

Speaking as someone who has worked both within the NHS and pharma, David explained the implications of these changes for people in industry. “On a tactical level, the NHS bodies, roles, people and boundaries will change – your customer lists, all the people you target, the functions that will affect your products. There’ll be incredible variation.”

He explained that those in the field are currently being motivated by traditional influences – clinicians – and the end game is clearest to only a few senior managers. The clinicians are largely in the dark, which has implications for pharma. “No matter how senior, clinicians are cut off from the pace of this and the discussions around it.

“The men and women in suits, who are driving these changes, are the ones who know what’s happening on ‘the other side of the hill’. That’s not a constituency that pharma has traditionally been able to access and have a rapport with.”

He also cautioned that, due to changing priorities, pharma could be caught out: “Pharma hasn’t realised that priorities in practice could change significantly. When you’re around the clinicians and the things that they want to do in these ACOs, there are some very different ways in which they express priorities, and the pace of this change will surprise many. By the time we get to the autumn, the NHS is going to look very different.”

 

Challenges for the future?

David used the example of ‘social prescribing’ – where GPs prescribe things such as friends, socialising and gym memberships for health improvement – to describe how the competition between prescribing and other care is one of the challenges that pharma could face.

“I’m not sure if pharma is ready to regard this area as competition. The clinicians are massive fans of this. There are opportunities, but there are certainly challenges, and the key thing is to be close to the reality on the ground.”

During the Q&A session, chair Michael Sobanja asked David if it was possible for pharma to support and add value to social prescribing. Describing the shift as “a chance for pharma collectively to embrace social prescribing,” David went on to say: “I’m a big champion of pharma and it really gets to me how little pharma is being represented in a positive way. Surely, if someone is depressed, social prescribing can help them, but the anti-depressants can help them too.”

 

What can pharma do?

David emphasised that although there are now “massive” opportunities for pharma, missing them for want of available information was no excuse for not being prepared, and that preparation starts at a local level. “Initially, a lot of this is going to be ‘offline’ to pharma, but gradually the websites, meetings and documents will be coming out – but you’ve got to stay close to the right people locally.” Rounding off the webinar, Michael asked David: “If you were a pharma sales and marketing manager, what would be the one thing you’d be trying to address, in order to get to grips with the shift that we’ve being describing?”

David had no hesitation in sharing his recommended plan of action: “I’d be identifying the doctors and the people who’d be leading the change, and I’d be all over them. Some companies are working out who will lead the hospital chains,” he revealed. “I would be all over the people who are actually setting the agenda, and around the NHS everybody knows the organisations who are going to be driving and shaping us.”

As more ACOs are established, the outcome that we all hope for is real benefits for patients. David believes that this is possible with new models, although they will represent radical change within the NHS and in terms of how industry works: “I hope that this will be a tangible change for patients.”  

 

Go to parallellearning.co.uk

 

David Thorne

Originally a mental health nurse, David has occupied senior positions within NHS hospitals and commissioning organisations for over 35 years. He is currently the Managing Director of Blue River Consulting, Chair of Washington Community Healthcare and Non-Executive Director of City and Vale GP Alliance. Go to blueriverconsulting.co.uk

 

 

 

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