NIA Fellow Arjun Panesar shares how a risk-share approach helped him overcome funding barriers for his innovation, Low Carb Program.You’ve got a fantastic innovation that can help millions of people, it’s loved by the NHS teams you’ve demonstrated it to, but the local NHS area can’t afford it. There’s no funding.

There are lots of reasons that innovations don’t work within the NHS, but when the only reason innovations aren’t being adopted is a lack of funding, not only is it a frustration, it’s to the detriment of patient and population health. Funding often halts a great vision in its tracks preventing even the lightest of explorations. What’s more, it is a massive frustration for healthcare teams who invest time, energy and passion into curating projects even before a business case is written. And for the innovators and NHS teams involved it can be just down-right demoralising – how can we possibly influence positive change?

Since being part of the NHS Innovation Accelerator, this has been by far the biggest barrier to adoption of the Low Carb Program.As we engaged with NHS localities, stakeholders rejoiced in the idea of scaling improved type 2 diabetes management and remission with a scalable, engaging platform. The patient health benefits and savings in de-prescribing were evident – but still, it was cumbersome to find budget. And even if there was budget, it would be too small to truly impact health at a population level.

As innovators, it’s not just services we are innovating – it’s pathways of delivery. Global healthcare is in a transition toward patient-based care, synonymous with value, rather than volume. Tseng et al. defined the value in healthcare to be the quality of care: typically measured through health outcomes.

With this in mind and our experience in other countries, earlier this year we implemented our first ‘gain-share’ model with an NHS CCG. The gain-share approach is a paid-on-results model, which, rather than requiring immediate upfront budget, can share in the success of innovation delivery. In our case, in sharing the savings of de-medication through patients who are de-prescribed medication as they improve their blood glucose control.

Value-based care does not mean cheap or economy care. Wellness and prevention are emphasised and care is evaluated through KPIs and results: quality of patient experience and outcomes, often with incentives for keeping populations healthy and out of hospital. It works well for all as it requires much smaller investment in the short-term, with the outcomes celebrated and shared in the long-term. It makes sense – if everyone is in it for the “gains”, then there is complete involvement and greater level of collaboration. It’s one team – rather than two – working towards shared goals.

The model reshapes how care is received by patients. What’s more, with lifestyle, behavior, and environmental factors accounting for 90% of disease risk, it enables a scalable approach to population health.

As NHS innovators, it is fantastic to actualise the benefits of digital health. In particular, democratisation of access to education and self-management for people to live healthier, happier lives.For more information on integrated care payment design watch this webinar series from NHS Improvement.