Clinical risk and integrated care: Lessons from Accountable Care Organisations in the United States

Integrated care can deliver a range of quality benefits for patients, but there has been little explicit reference to clinical risk and patient safety benefits in the UK. A review of literature presented here sets out some of the patient safety benefits of provider integration that have been identified in the literature. This article sets out some lessons which can be drawn from the US experience in developing the Accountable Care Organisation model. The success of this model has been measured using metrics which include care coordination and patient safety metrics. These were based on clinical and services research conducted largely in the US. The experience of putting this into practice at one successful Accountable Care Organisation is presented, highlighting the benefits of population as well as individual level risk management. We set out the conceptual framework that can be used to ensure that the critical enablers of integration and patient safety are addressed. In conclusion, we highlight some immediate lessons that the UK could learn from.