Presentation (CTI)

OBJECTIVES: Objectives: From April 2026, English Integrated Care Boards (ICBs) are expected to act as strategic commissioners within a flat financial envelope, yet a practical operating layer to translate population need into explicit, auditable reallocation decisions is often missing. To describe and illustrate a Healthcare Value Framework that allocates ICB expenditure to maximise outcomes per pound across a whole population.
METHODS: Methods: The framework uses HealthStrata® segmentation of NHS England's 57.3 million-person population into seven clinical states plus maternity. Within each segment it stratifies severity and decomposes spend by point of delivery (A&E, non-elective inpatient, outpatient, elective, out-of-hospital and medicines). Care gaps are quantified against NICE-aligned pathways across prevalence→diagnosis→treatment→optimisation. Opportunity is estimated across four levers (pricing, demand optimisation, care-gap closure and elimination of unwarranted variation) using variation analysis against best-decile comparators (controlling for age and deprivation) and risk reduction from guideline attainment, drawing on 143 interventions with published ROI.
RESULTS: Results: In the national demonstrator (England, 2024/25; £180bn), multi-morbidity accounted for £68.4bn (38%) while representing 15% of the population; per-capita spend ranged from £520 (generally healthy) to £53,100 (end-stage/end-of-life). The framework highlighted substantial care gaps (e.g. 35% cholesterol; 60% CKD diagnosis; 63% LDL and 72% HbA1c not at target among those treated) and translated ~45 interventions into a prioritised portfolio and 10-year spend-shift projection. Real-world validation: in North West and North East London (each ~1.5-2m), inner boroughs adopting integrated, segmentation-led care sustained a 40% reduction in emergency admissions, versus a 10% increase in outer boroughs that did not; this is consistent with evidence that integration takes 10-15 years to embed but then delivers double-digit impact.
CONCLUSIONS: Conclusions: A segmentation- and care-gap-based approach provides a transparent “middle layer” between macro benchmarking and pathway programmes, enabling ICB boards to prioritise investments and disinvestments that improve outcomes and affordability in a repeatable, auditable way.