Accountable care – aligning incentives with outcomes

Alasdair Liddell (Independent Consultant, London, UK)
David Welbourn (Centre for Better Managed Health and Social Care, Cass Business School, City University, London, UK)

Journal of Integrated Care

ISSN: 1476-9018

Publication date: 15 June 2012



The paper seeks to move the integrated care debate forward by exploring what contributes to improved quality and efficiency, and to consider the practical consequences of translating a model exemplifying that success into the English context.


The authors contend that a key driver is to unite the whole system in a single purpose, incentivising all parts to align with that single shared purpose. Although designed for a very different healthcare system, the Accountable Care Organisation (ACO) model exemplifies this principle – aligning incentives across a variety of providers to achieve practical integration driven by outcomes.


The authors explore what an ACO model would comprise if transposed, demonstrating that it offers the short term gains claimed for integrated care whilst also providing a structured framework setting out a clear long term roadmap for both commissioner and provider evolution, hitherto not addressed by policy. Drawing analogies from other industries it is suggested that potential conflict between integration, competition and choice is exaggerated. The discussions with leaders and whole community groups has consistently been found to provide fresh and helpful insight.


In this paper, the authors bring fresh insight to what aspects of integrated care contribute to future success and then explore why and how that insight can be applied by translating growing experience from elsewhere into the English NHS setting.



Liddell, A. and Welbourn, D. (2012), "Accountable care – aligning incentives with outcomes", Journal of Integrated Care, Vol. 20 No. 3, pp. 138-145.

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Emerald Group Publishing Limited

Copyright © 2012, Emerald Group Publishing Limited

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