Optum scoops up £7m over 9 months for telling execs how to shrink the NHS

Optum – a healthcare services subsidiary of USA global healthcare company United Health – is increasingly remaking the NHS in its own image, thanks to its former employee Simon Stevens – now Chief Exec of the NHS England quango.

It turns out that more than 55 Clinical Commissioning Groups have been trained and coached by the Optum Alliance, through NHS England’s 2018 Commissioning Capability Programme and its offshoots – the Aspiring Integrated Care System Programme and the Population Health Programne (new blog posts coming soon on both of these).

Aspiring Integrated Care Systems are taught by OptumAlliance how to control the costs of all the participating commissioners and providers. This requires a so-called ‘risk-reward sharing’ contractual model imported from USA Accountable Care Organisations – which were set up to cut healthcare costs.

A chilling NHS document, “Risk and Reward Sharing for NHS Integrated Care Systems“, touts

‘the opportunity to co-opt and incentivise a provider to moderate growth in healthcare demand by sharing in the savings or cost over-runs’.

How come the Parliamentary opposition hasn’t grasped this nettle? Have they been asleep on the watch?

OptumAlliance is training Sustainability and Transformation Plan leaders that NHS England reckons need “help” with integrating the local health system in the United Health way

Meanwhile all the time Optum is building relationships with those in charge.

Optum claws £7m from NHS England in 9 months

Simon Stevens launched the Commissioning Capability Programme in January 2018, with Optum Alliance as the provider.

Between April 2018 and January 2019, NHS England paid Optum £6,784,671.33 to tell NHS and Local Authority Executives how to make massive cuts to NHS and social care spending, by imposing cost-cutting USA Accountable Care models in their areas.

Last year the government rebranded Accountable Care as Integrated Care, in a futile attempt to remove the connotations of the USA’s Medicare/Medicaid system.

Whatever you call it, Accountable Care is clearly a means of increasing corporate profits in the life sciences and digital and data sectors, and attracting overseas investment in the UK post-Brexit – regardless of the ethics of the investors.

A key aim of Accountable Care is to cut the labour costs of healthcare by a combination of making patients care for themselves and systematically replacing skilled, qualified staff with capital in the shape of big pharma, biomedical/life sciences, digitech and data products.

PwC snout in NHS trough

As part of the Optum Alliance, PwC is advising NHS and Local Authority executives on how to set up the Accountable Care models that will enable its global clients to profit from opportunities for “new entrants” to the health and wellbeing sector.

Its 2016 report: Capture the Growth: Opportunities for new entrants in healthcare and wellbeing announced:

“The time is ripe for new ideas in UK healthcare. Some of those new ideas and solutions will come from new sources – organisations which traditionally have not been involved in healthcare, fitness or wellness. Worldwide, the players on the healthcare pitch are changing. And the UK is no exception. New entrants are emerging, disrupting the old ways of doing things.”

The report’s Foreword is by Alan Milburn, PwC Health Industries Oversight Board Chair, former New Labour Secretary of State for Health and cheerleader for NHS privatisation:

“The trick is to find ways of harnessing the traditional strengths of the UK’s healthcare system and marrying them with the new insights and innovations that new entrants can bring.

What matters most is connecting with individual consumers… they have an open mind about who provides services and how and where they are provided.

That opens the door to organisations who can find a way to give people what they need in new ways and to partner with the NHS and private healthcare providers in doing so. For those who are prepared to walk through that door there is a bright future ahead. New entrants can help reshape the health, fitness and wellness landscape in the UK.”

Alan Milburn has form in trading his former New Labour government position for spondulicks, by telling USA healthcare companies how to profit from NHS privatisation opportunities – as ck999 reported last year .

Like PwC, Optum is intent on expanding into fitness and wellbeing

Maybe this shared business interest is the basis for their “Alliance”?

An Optum head honcho is on record as saying that consumerism is going to change healthcare more than any other trend over the next decade.

This apparently means Optum reckons people are increasingly shopping for health, mainly through digital technology. Things like digital weight loss programmes including streaming fitness classes and digital maternity programmes that track pregnancy.

The word is that,

“Optum will pursue investments as well as acquisitions to push into consumer space.”

What’s the betting that all the “consumer-centric” fitness and wellbeing companies that get business in the new OptumAllianceNHS will soon be snapped up by Optum? Just like VirginCare snapped up GPs’ out of hours companies and so gained entrance to the NHS.

Telling NHS and Local Authority execs how to turn the NHS into a copy of United Health

Optum Alliance’s advice basically amounts to showing executives of local NHS, social care and public health “systems” how to operate like an Accountable Care Organisation – accountable to a health insurance company for:

• itemising costs on a patient-by-patient basis – you can find out more here (link coming soon)
• segmenting the population in order to identify high cost patient groups (aka risk stratification)
• restricting patients’ access to treatments in order to cut costs.

Those Accountable Care/ health insurance company measures ditch the principle of the #NHS4All – that our NHS offers the full range of treatments to everyone with a clinical need who, together with their doctor, decides this is appropriate for them.

The new Primary Care Networks are key to implementing these measures – which in the past have not gone down too well with GPs.

Five years ago, in April 2014, NHS England announced a new, one year Enhanced Scheme to pay participating GPs up to £2.87/patient to introduce a “risk stratification” model. A GP poll found that only 51% of GPs planned to sign up for this scheme because of fears that it would consume huge amounts of practice time.

Reports from Harrow Clinical Commissioning Group in NW London and Bath NE Somerset, Swindon and Wiltshire CCGs (just 4 of the 55+ CCGs which NHS England “invited” to take part in the Commissioning Capability Programme) show risk stratification is a focus of OptumAlliance’s “advice”, along with closely-related “demand management” topics:

• Identifying the most costly patients who are at risk of unplanned hospital admissions, in order to reduce their admissions and cut costs. (Where this has been done elsewhere in England, it has led to INCREASED hospital admissions and costs.)
• Speeding up hospital discharges.
• Restricting patients’ access to a growing number of operations and treatments
• Telling CCGs across an STP how to form a single Management Team (incorporating the STP) in order to commission services “at scale” and cut costs. (Begging the question of what local services will be cut in order to centralise them.)

The NW London Sustainability and Transformation Partnership is already strongly involved with Optum, which manages the referrals for the populations of both Ealing and Hounslow.

This is also the Sustainability and Transformation Partnership where Imperial College is located where Mr Darzi (who is also in charge of driving drugs and technology into the NHS) heads the Institute for Global Health and Innovation – which is partnered with OptumLabs. Darzi is of course also on NHS Improvement’s board.

Harrow Clinical Commissioning Group says that,

“The Optum Alliance has fielded its most senior partners, directors and doctors to act as programme coaches. All coaches are experienced leaders in complex business systems..”

Says it all, really, doesn’t it? The NHS is no longer seen as a health service, but a complex business facing financial challenges.

This is all part of the financialisation of the NHS documented in Marion McAlpine’s photo exhibition, How Come We Didn’t Know?.

The NW London Shaping a Healthier Future scheme may be dead. But hospital cuts and NHS and social care spending cuts are still on the table.

More info here about how Optum Alliance told Harrow to cut NHS and social care costs.

And info here about how Optum Alliance got 3 Clinical Commissioning Groups to work as one in Bath and NE Somerset, Swindon and Wiltshire Sustainability and Transformation Partnership, so that they can “commission services at scale.” Begging the question of what local services they will cut in order to centralise them.

In April 2019, ck999 reported that NHS England had hired the Optum Alliance (Optum Healthcare Solutions UK together with Pricewaterhouse Cooper) to:

• develop the Integrated Care System in South East London, and
• to work with four sustainability and transformation partnerships in the West Midlands to “help progression towards integrated care systems”.

Now we’ve found that was only the tip of the Optum Alliance iceberg and it’s rammed a big hole in our NHS