Last week, two NHS Trusts have become the first to win national approval to hold an integrated health organisation (IHO) contract, this news made me reflect on discussions I had years ago (during my NHS days) with the CEO of a US Hospital in the early days of the Accountable Care.
The Summa Health system in Accron Ohio had taken on an accountable care contract with a large steel company – the plan was for the health system to manage the health needs of employees and families (saving the steel provider money by providing the service at less cost).
The reflection of the CEO was that Summa Health had taken at least two years to recognise that the key to delivering effective and efficient accountable care was to invest in community and primary care. Summa had made the mistake of building its accountable care on its hospital base rather than investing in the physicians (GPs) that it contracted with or the community services it provided.
IHO contracts for the NHS may be the right way forward – the purchaser/ provider split has probably run its course – however we need to do everything we can to ensure that our IHO providers recognise that investment outside hospitals will be the key to their viability and success. The current system has clearly failed to find a way of moving resources out of hospitals, and our hospital trusts remain nervous about the merits of the so-called left shift as the HSJ recently reported:
Sir Jim, pressed on the transfer of funding into primary and community services promised in the 10YHP, said “there was wariness about doing so, because of a lack of evidence and experience that it will remove activity and costs from hospitals. What they [hospital leaders] are worried about is the money shifts but the patients don’t, which is what’s happened before”.
The challenge for our hospital trust based IHOs is how to build integrated care from a community (neighbourhood) base upwards and to take on the responsibility for the health of the population served and not just those who cross the threshold – a very different leadership challenge!
