PMU65 ANALYSIS OF THE EARLY PERFORMANCE OF INTEGRATED CARE SYSTEMS IN THE UK USING A DIFFERENCE-IN-DIFFERENCES APPROACH

Abstract

The first integrated care systems (ICSs) in England were formed in 2017, in a move towards a more cohesive model of care delivery that better serves the health needs of local populations. ICSs originate from the Accountable Care Organisation model in the USA. NHS England has proposed an incentives framework for ICSs, in which financial rewards in addition to the standard capitation payments are given based on performance against national indicators for quality standards. The aim of this study was to assess the early performance of ten ICSs in England against Sustainability and Transformation Partnerships (STPs) in England that have not yet adopted an ICS model. Using Hospital Episode Statistics data (copyright NHS Digital 2018), a difference-in-differences analysis was performed to compare the first wave of ten ICSs against 34 STPs. Outcomes were measured according to selected metrics from the proposed incentives framework. Markers of secondary care utilisation were non-elective activity, accident and emergency (A&E) attendance and admissions for ambulatory care sensitive conditions, and of quality were national standards for waiting times. ICSs demonstrated a greater decrease in the number of excess bed days than STPs, with a between-group difference of 2100 excess bed days that was probably driven by a decrease in delayed transfers of care. However, there was a bigger increase in 30-day readmission rates in the ICS cohort, giving a difference of 0.13 per 1000 members of the population between cohorts. Integration of care did not affect the number or rate of A&E attendances or waiting time performance. These mixed results suggest that ICSs are performing well for some metrics but need to improve for others. Incentivisation of measures leading to longer-term improvements in population health is pivotal in ensuring the success of the ICS model in England.