title: Accountable care around the world: a framework to guide reform strategies.
abstract: Accountable care--a way to align health care payments with patient-focused reform goals--is currently being pursued in the United States, but its principles are also being applied in many other countries. In this article we review experiences with such reforms to offer a globally applicable definition of an accountable care system and propose a conceptual framework for characterizing and assessing accountable care reforms. The framework consists of five components: population, outcomes, metrics and learning, payments and incentives, and coordinated delivery. We describe how the framework applies to accountable care reforms that are already being implemented in Spain and Singapore. We also describe how it can be used to map progress through increasingly sophisticated levels of reforms. We recommend that policy makers pursuing accountable care reforms emphasize the following steps: highlight population health and wellness instead of just treating illness; pay for outcomes instead of activities; create a more favorable environment for collaboration and coordinated care; and promote interoperable data systems.
authors.affiliation: Mark McClellan is chair of the Accountable Care Forum at the World Innovation Summit for Health (WISH), Qatar Foundation, and a senior fellow and director of the Health Care Innovation and Value Initiative at the Brookings Institution, in Washington, D.C.
authors.forename: Mark
authors.initials: M
authors.lastname: McClellan
authors.affiliation: James Kent is a partner and managing director in the Boston Consulting Group's London office, in the United Kingdom.
authors.forename: James
authors.initials: J
authors.lastname: Kent
authors.affiliation: Stephen J. Beales (s.beales@imperial.ac.uk) is the forum fellow for the Accountable Care Forum at WISH and a policy fellow at the Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, in the United Kingdom.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Beales
authors.affiliation: Samuel I.A. Cohen is a consultant in the Boston Consulting Group's London office and a research fellow at St. John's College, University of Cambridge, in the United Kingdom.
authors.forename: Samuel I A
authors.initials: SI
authors.lastname: Cohen
authors.affiliation: Michael Macdonnell is the policy fellow for the Accountable Care Forum at WISH; an honorary fellow at the Institute of Global Health Innovation, Imperial College London; and head of strategy at NHS England.
authors.forename: Michael
authors.initials: M
authors.lastname: Macdonnell
authors.affiliation: Andrea Thoumi is a research associate at the Engelberg Center for Health Care Reform, Brookings Institution.
authors.forename: Andrea
authors.initials: A
authors.lastname: Thoumi
authors.affiliation: Mariam Abdulmalik is managing director at the Primary Health Care Corporation, in Doha, Qatar.
authors.forename: Mariam
authors.initials: M
authors.lastname: Abdulmalik
authors.affiliation: Ara Darzi is executive chair of WISH, Qatar Foundation, and director of the Institute of Global Health Innovation, Imperial College London.
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
mesh_terms: D060866:Accountable Care Organizations / Q000191:economics / Q000458:organization & administration*; D014943:Global Health; D018166:Health Care Reform / Q000191:economics / Q000458:organization & administration*; D006291:Health Policy; D006801:Humans; D017146:Models, Organizational; D011787:Quality of Health Care
keywords: Accountable Care; Cost of Health Care; Financing Health Care; Organization and Delivery of Care