Saturday, 10 February 2018

human guinea pig trial U.S. accountable care systems

NHS England boss selling U.S. healthcare as 'solution' to NHS crisis
If you live in the Morecambe Bay area or on the Fylde Coast then pay heed...All healthcare providers and commissioners in your area have agreed on a Memorandum of Understanding to set up a U.S. style Accountable Care System. 

Contentious NHS reforms: The outcomes of human 'guinea pig' trial U.S. accountable care systems are still unknown, yet they are still going ahead...

Memorandum of Understanding (MoU) Morecambe Bay Area 

Accountable Care System (ACS) - sample area Bay Health (Shadow ACS until April 2018)

Objectives: bring together (integrate) ALL health and care providers under a single partnership. Pool resources and demand manage [ration] health & care services and medicines.

■ Reducing cost per capita for our 365,000 population (£ spent per person)

3.2.1 Estates management and capital investment
 Conduct an  audit of all land, buildings and equipment "owned" by the ACS;

Above estates and buildings owned by each partner will now become responsibility of the ACS and ALL estate and buldings will be opened up for sale to further the ACS

The Bay ACS will either “make or buy” (provide directly or commission) health and care services for the Bay population – a hybrid of commissioning and provider functions. With a focus on prevention [preventing patients accessing services] with increasing focus on community and getting people to take responsibility for their own health and wellbeing.

Budget type: Capitation
■ Demand management restricts patients’ choice.
■ providers cherry pick types of procedures choosing most lucrative high-turnover
■ ACS historically have incentives to only take healthier (i.e. more lucrative and less time-consuming) patients.
■ difficult to evaluate performance between providers/clinicians
■ Capitation can encourage a doctor or practice to take on too many patients, more than they can ideally care for.
■ incentive is to make financial surplus to pass back to ACS shareholders
■ Over-treating: Capitated payments encourage doctors/practices to take on too many patients, more than they can ideally care for.
■ over-prescribing and unecessary referrals to specialists instead of general clinicians
■ ACSs are trialling schemes and playing with patients lives. they have No safety net for patients if budget is exceeded, capitation requires increasing, or under-funded or even if prevention schemes fail

Taking the 'Social' out of 'Social Care'
Social care is currently means tested: when local authority care services are transferred to an ACS/ACO the means tests could then apply to both the 'care' and 'health' services elements. That is, patients could end up taking a means-test, and if their income is above a certain limit they'll have to pay for health services that were previously included as free on the NHS.

Accountable Care - provided by accountants who care about finance
Historical List (not exhaustive) E&OE....

  • ACS Scheme taken from U.S. Health Maintenance Organisations (HMO) and failed Obamacare model.
  • ACS Scheme being rolled out by NHS England's CEO Simon Stevens ex president of United Health - Americas largest private health insurer.
  • scheme has full support and backing of health secretary Jeremy Hunt who in 2008 co-authored party policy pamphlet calling for NHS to be denationalised [privatised].
  • 2012 Health & Social (H&SC) Care bill introduced by the then health minister, Conservative minister Andrew Lansley opens up NHS market to any private [qualified] provider paving way for NHS privatisation.
  • 2013 H&SC Act comes into effect replacing 152 primary care trusts with 222 GP-led Clinical Commissioning Groups (CCGs) in England
  • CCGs set to work liasing with quangos NHS England and 22 Commissioning Support Units (CSUs) 
  • 2015 election - NHS England's five year forward view [FYFV] document for U.S. style healthcare shelved. 
  • 2015 - Conservatives win election, five year forward view document for U.S. style healthcare dusted off and distributed 
  • England divided into 44 'footprint' areas with providers and commissioners in each footprint told to draw up a 'sustainability & transformation plan (STP) in line with five year forward view document.
  • Providers and commissioners underfunded, unfair contract imposed on junior doctors; BMA mount weak opposition.
  • CCGs begin rationing of healthcare services and medicines (earliest signs of 'denial of care' seen mainly in U.S. health insurance policy claims
  • 2015/16 - five models of care from FYFV document start trials across 50 vanguard sites in England. these are the test beds for ACSs
  • Protests begin around secrecy of STP documents. Con/Lib Coalition government refuse to reveal contents of STPs after call by shadow health for transparency
  • 2016 - name changed by NHS England from ST Plan to ST Partnership indicating arrival of U.S. Accountable Care Organisation (ACO) type model. Legal challenges begin as to how ACS/ACO could remove purchaser/provider split without change in legislation
  • 2016 - CEO of NHS England invites U.S. Medicare director over to England to re-affirm position to Health sec. on benefits of demand management in elderly care
  • 2017 - Mass demonstrations against STPs throughout England and in London
  • 2017 [June] - Eight shadow Accountable Care System areas established with two more added 
  • 2017 - NHS England confirmed the first wave of accountable care systems (including two health devolution deal areas)
  • Judicial reviews start on legality of forming ACSs/ACOs
  • 2018 [Feb] - NHS campaigners rally in London against austerity cuts
  • 2018 - NHS England pause ACS rollout for 12 week listening exercise due to public not understanding what ACSs involved
  • 2018 - NHS England, during its pause period, tell providers to go full speed ahead with ACS plans...

15 Jun 2017 - HEALTH bosses across the Fylde coast say they are 'delighted' to have been chosen as one of only a few areas in the country to receive support to progress towards being an accountable care system.
Fylde coast healthcare leading the way – Your Care Our Priority

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