Focusing accountability on the outcomes that matter

Many nations are seeking to provide better-quality healthcare at lower cost. As healthcare becomes more personalized and prevention-oriented, this goal will be even more difficult to achieve through existing models of healthcare payment and delivery.
Healthcare requires a new operating model. Resources must be redirected to where they can best be used, often away from the hospital, and sometimes away from the clinical setting altogether, and instead to patients themselves. And traditionally separate providers must now work together in new ways to deliver this customized care. This is all the more crucial as an increasing source of demand for healthcare is from people with one or more chronic diseases.
Accountable care is an emerging model for healthcare that addresses this central health policy challenge. It aims to boost quality and reduce cost by reallocating resources on the basis of measurable improvements in care. Better health, better care, and lower costs matter to patients and populations. But traditional payment systems and regulations often do not support the necessary steps – steps such as co-ordinating care, following the latest evidence-based practices, using new technologies, and involving different kinds of
providers and innovations in delivering care. Tying payments to the things that matter to people and populations, by moving away from silos or fee-for-service payments focused on supporting providers, can enable innovative reforms in care.
What precisely is accountable care and what can it realistically deliver? How can existing systems make the journey towards more accountable models? And what can policy-makers do to make accountable care a reality? Our report seeks to answer these key questions by drawing on existing examples of accountable care from around the world. Although healthcare systems vary, we distil four policy recommendations that all policy-makers can adopt as they start to put accountable care into practice. These recommendations involve transformations in perspectives, payments, collaboration and competition, and data exchange. We describe
incremental steps that policy-makers can begin to take right away in order to achieve these transformational changes.
Policy-makers should seize the moment to deliver transformational changes in healthcare. Across the world, in very diverse healthcare systems, payers and providers are experimenting with accountable care. They are implementing payment reforms tied to results, as a way of supporting innovative approaches to care that will
have an important impact on health and costs for the populations affected. Rather than working in isolation, as we have too often done in the past, we believe now is an ideal time for a concerted and ongoing initiative to share global experiences, develop more evidence from these experiences, and thereby gain a better understanding of the implications of implementing accountable care. Our hope is that the collected
insights within this report will provide a catalyst for this international collaboration, as we all start to make the transformational changes to our healthcare systems that will deliver better care at lower cost for the populations that we serve.

Professor The Lord Darzi, PC, KBE, FRS
Executive Chair of WISH, Qatar Foundation
Director of Institute of Global Health
Innovation, Imperial College London

Dr Mark McClellan
Senior Fellow and Director of the
Initiative on Health Care Innovation
and Value, Brookings Institution