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The American Journal of Accountable Care June 2018
Amazing Grace: A Free Clinic's Transformation to the Patient-Centered Medical Home Model
Jason Alexander, BS, PCMH CCE; Jordon Schagrin, MHCI, PCMH CCE; Scott Langdon, BA; Meghan Hufstader Gabriel, PhD; Kendall Cortelyou-Ward, PhD; Kourtney Nieves, PhD; Lauren Thawley, MSHSA; and Vincent Pereira, MHA, PCMH CCE
Lessons Learned in Implementing Behavioral Screening and Intervention
Richard L. Brown, MD, MPH
The Intersection of Health and Social Services: How to Leverage Community Partnerships to Deliver Whole-Person Care
Taylor Justice, MBA, President of Unite Us
Case Study: Encouraging Patients to Schedule Annual Physicals
Nicholas Ma
Effects of an Integrated Medication Therapy Management Program in a Pioneer ACO
William R. Doucette, PhD; Yiran Zhang, PhD, BSPharm; Jane F. Pendergast, PhD; and John Witt, BS
Are Medical Offices Ready for Value-Based Reimbursement? Staff Perceptions of a Workplace Climate for Value and Efficiency
Rodney K. McCurdy, PhD, and William E. Encinosa, PhD
Currently Reading
Utilizing Community Resources, New Payment Models, Technology to Deliver Accountable Care
Laura Joszt, MA

Utilizing Community Resources, New Payment Models, Technology to Deliver Accountable Care

Laura Joszt, MA
At the Accountable Care Delivery Congress, speakers discussed ways to address social determinants of health, use payment mechanisms as levers, and forge connections through technology.
The American Journal of Accountable Care. 2018;6(2):36-37
The United States healthcare system is undergoing a shift to value-based care that has been uneven across sectors and parts of the country, but there are plenty of organizations pushing forward, explained speakers at the forefront of the movement during The American Journal of Managed Care®’s Accountable Care Delivery Congress, held May 11, 2018, in San Diego, California.

During her keynote speech, Suzanne Delbanco, PhD, MPH, executive director of Catalyst for Payment Reform, explained that employers may sometimes be intimidated by the idea of purchasing healthcare, but they are in a position to transform the market.

Although employers are interested in new models tying payment to value, Delbanco’s group believes that each of the myriad of payment types in healthcare has a place, including fee-for-service.

“We don’t believe that we’re necessarily moving from traditional fee-for-service all the way to global payment and [will] reach Nirvana and then we’re done,” she said.

Employers are also making efforts to control costs without impacting quality through new benefit designs, provider network arrangements, and providing services like onsite or near-site clinics or telehealth as alternative settings of less expensive care.

Attention to Social Needs
The first panel of the meeting focused on new ways of delivering care to address social determinants of health. Rachel Gold, PhD, MPH, of the Kaiser Permanente Center for Health Research and OCHIN, explained that the biggest challenge to addressing social determinants of health that she is trying to overcome is how community health centers can start to collect social determinant data and document them so providers can actually be aware of them.

Developing care plans for patients is a futile effort if providers don’t know a patient’s social needs. For instance, if a patient is homeless, a provider shouldn’t prescribe a medication that needs to be refrigerated, she explained.

“Sounds obvious, but if the provider doesn’t know the patient’s homeless, because it’s not in the record, and they didn’t think to ask, then they’re going to create a serious barrier to the patient acting on their care recommendations,” Gold said.

She added that her research has also shown that sometimes there are reasons to not screen for social needs, as the providers don’t always have a way to address the patient’s needs. In the Portland area, there is a housing crisis, so if a provider finds out that a patient is homeless, the provider might not actually be able to do anything about it.

Karin VanZant, of CareSource, pushed back by emphasizing that identification of social needs has to happen. There are always resources available, even if certain geographic areas may have supply­-and-demand issues. The trick is to knit together the social fabric and safety net within the geography.

Carter Wilson, MCOM, of the Camden Coalition of Healthcare Providers, added that providers need to tailor screening questions to the available resources within a community. Still, he finds that primary care physicians are hesitant to ask questions about social needs because they “don’t want to open that can of worms.” He’s trying to train them to be comfortable bringing up these issues.

“It’s only a can of worms for the provider—not for the patient,” Wilson said. “The patient is living this life. They’re not traumatized by their own life or talking about their own life. So, it’s a provider anxiety about what they’re going to do to their patients, and it’s incorrect.”

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