Primary and secondary care integration in delivery of value-based health-care systems.

The Five Year Forward View ( NHS England, 2014 ) endorses outcomes-based approaches and integrated care systems. This article looks at the role and functions of hospitals in value-based health-care systems, following Porter's value-based health-care framework. Changes will be required not only in the way health care is organized within a hospital in the form of so-called integrated practice units, but more importantly primary and secondary care will have to work together to realize value for patients across the health-care pathway and system. It will be necessary to build an enabling IT platform that facilitates an integrated dataset across primary and secondary care to measure outcomes and costs across patient pathways. Finally, new payment models will be required to remove current barriers and allow clinicians to do the right things for their patients without organizations being penalized. The final section describes current maturity of the system, opportunities and challenges in the UK.