The economics of health service transformation: A business model for care coordination for chronic condition patients in the UK and US

Abstract

Purpose

This is a report on a recent development of an innovative coordinated care solution named the Care Coordination Centre (CCC), which targets coordinated care arrangements for a populations expected to benefit the most. The purpose of this paper is to identify the patients who might comprise this group, and to assess the best ways to meet their health, community, and social care needs before and after introducing the coordinated care solution across care settings.

Design/methodology/approach

This is a summary of the author’s experience in the design and development of a care coordination business model for US providers and UK Clinical Commissioning Groups (CCGs) using coordinated care not only as a cost-cutting tool, but as a mechanism for creating a flexible and responsive patient-centered care. The author makes an assessment of the economic benefits of coordinated care resulting from: the shift to less costly interventions; reduction in readmissions; reduced unplanned admissions; increased time allocation efficiency of healthcare staff; and the overall reduction in per-patient costs.

Findings

The health and social care systems in the USA and the UK are facing the biggest challenges in their history. Payers, providers, governments, and communities need to work to build better coordination and integration mechanisms to manage the increasing demand on health and social care in a period of stagnant health and social care budgets. New innovative models of coordinated care have been developed in both countries, at the local economy level, as the health service systems are undergoing crucial transformation from a supply to a demand-based model. In the UK, the Trafford CCG has commissioned a new CCC, responsible for the delivery of high-quality coordinated care. The CCC is designed to function at clinical, service, and community levels across multiple providers to cover, among other tasks, chronic condition patient case management, risk stratification of preventative, elective, and unscheduled care for the whole region.

Originality/value

Insights from the work with Trafford CCG would be of considerable methodological and practical interest to researchers, policy makers, commissioners, healthcare professionals, and innovators.

Citation

Rachev, B.T. (2015), "The economics of health service transformation: A business model for care coordination for chronic condition patients in the UK and US", Clinical Governance: An International Journal, Vol. 20 No. 3, pp. 113-122. https://doi.org/10.1108/CGIJ-07-2015-0024