Page 3 - New and Emerging Customer Types

general medical service (GMS), as well as mental health services, into one provider organisation such as a PAC’s system.
Integration covers a whole spectrum of informal and formal contracting arrangements. Often the reasons for driving the need for integration will help decide which formal arrangement will be most appropriate for a given population.
It is important for teams who are considering integration, to give thought to the reasons to make the changes and what the clinical drivers for integration are. Furthermore, as part of
the decision-making process, consideration needs to be given to the financial drivers and whether the new model is financially sustainable.
The table below describes the spectrum of arrangements that can exist between providers. You will see these types of arrangements across your own local health economies and provider networks.
Figure 1
Loose Arrangement Tight Arrangement
Non- Contractual
Contractual
Corporate
Merger /Acquisition
Loose Federation
Formal Federation
Alliance
Integrator
Prime
Corporate Joint Venture
Single Provider
No requirement
for a legal agreement to be entered into between parties. These parties simply retain their individual clinical service contracts and agree to collaborate and work together on an ad hoc basis
Similar to a loose federation but some form of non-binding agreement such as a memorandum of understanding (MoU), Heads of Term (HoT)/Collaboration Agreement is entered into between the parties to regulate the relationship by agreeing certain morally binding standards and behaviours
Each provider enters into an individual service contract with the commissioner and enters into an overarching alliance contract. The Alliance contract sets out how the services are going to be delivered in an integrated manner and apportions risk and reward between the parties, based on common outcomes.
A Provider is appointed to manage clinical services provided by other organisations making up the care pathways but the integrator will not provide the clinical services themselves
All of the relevant services are contracted for by one party on behalf of the other joint venture parties. “The Host” manages the prime contract in accordance with the joint venture agreement that the parties have entered into and sub contract relevant service to each other’s parties
Involves the formation of a separate corporate vehicle (a company, a limited liability partnership (LLP), a community interest company (CIC)).
- Shareholder vetoes (reserved matters) and shareholder decision- making.
Two or more independent organisation come together under common control to form a single provider
(NAPC, 2018)
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