Project Description
Objectives
Attain supported the West London CCG, in 2015 to develop a pioneering whole systems approach for how care would be delivered for its older adult population, called My Care My Way (MCMW).
This involved;
- Supporting the CCG through co-designing and delivering the model of care and implementing transformational change with patients, carers, providers, commissioners & clinicians.
What we did
Our support has involved:
- Building an understanding and shared vision amongst providers about the roles they play in the system and the opportunities for transformation
Designing the model of care and community hubs with providers, and aligning with wider services in the system
Supporting the business case for investment through the governance of the CCG and providers
Designing the programme management and governance
Designing a new workforce model – with new roles, including case managers and Health & Social Care Assistants (HSCAs)
Our impact
Published evaluation findings in 2018, two years on from commencement of services, show Attain enabled the following impacts to be achieved for the system:
- patients, carers and GPs speak highly of the service and morale amongst our new Case Managers and Health & Social Care Assistants is high.
MCMW reduced non-elective inpatient costs, elective inpatient costs and A&E costs.
MCMW has increased Patient Activation Measure (PAM) scores by 2 points, an amount the licensor of PAM says correlates to a 4% decrease in hospitalization and 4% increase in medication adherence in the US health system.
Find out more about Integration