The latest piece in HHS’ roadmap to move the healthcare industry to value-based payments is the Accountable Health Communities model. Here are 5 things to know about how this model addresses social determinants of health.
The latest piece in HHS’ roadmap to move the healthcare industry to value-based payments is the Accountable Health Communities model. This pilot project from the Centers for Medicare and Medicare Services Innovation Center will place focus on health-related social needs of Medicare and Medicaid beneficiaries.
The program is providing up to $157 million in funding for up to 44 recipients to test if addressing these social needs can improve quality and affordability of healthcare. Learn the basics of the new model:
1. Addressing social determinants of health.
Social determinants of health are the conditions that influence the health of individuals, including money, resources, food security, housing, and social supports. These social determinants can all impact an individual’s health.
“We’re making an investment at the community level to build that connection” between social determinants of health with the clinical care delivery system, said Patrick Conway, MD, MSc, deputy administrator for innovation and quality and chief medical officer at CMS.
2. Health is more than just what happens inside the doctor’s office.
At the AcademyHealth National Health Policy Conference in Washington, DC, Lewis Sandy, MD, senior vice president of Clinical Advancement at UnitedHealth Group, explained that new research has shown that while there are certain issues that can be addressed through medical care, but “many others require cooperation and engagement of many other parts of society.”
When HHS announced the new model, Secretary Sylvia M. Burwell explained that the agency is recognizing that more is involved with keeping people healthy than what “happens inside a doctor’s office.”
3. Partnering with the community.
The new Accountable Health Communities Model will build alignment between clinical and community-based services so beneficiaries struggling with unmet needs related to their health can be aware of any services that are available in their area and can receive assistance to use them.
Track 1 Awareness: increase beneficiary awareness of available community services through information dissemination and referral
Track 2 Assistance: provide community service navigation services to assist high-risk beneficiaries with accessing services
Track 3 Alignment: encourage partner alignment to ensure that community services are available and responsive to the needs of the beneficiaries
The so-called “bridge organizations” that will receive funding to participate in 3 tracks:
4. Advancing the move to value-based care.
HHS called the Accountable Health Communities Model a tool to move the healthcare system to “one that rewards doctors based on quality, not quantity of care.”
The new model was released almost a full year after HHS announced in 2015 that it was setting a timeline to move healthcare payment for Medicare to a value-based system. Burwell said that the model is a step toward building a system that spends healthcare money more wisely, while improving health of beneficiaries.
5. Advances the move to address health equity, vulnerable populations, and healthcare disparities.
The announcement of the new ACO model followed just months after CMS released a plan to address health equity in Medicare and also proposed protections to reduce discrimination and disparities in healthcare.
Addressing social determinants are a way to promote health for vulnerable populations and to achieve health equity, whether it is to improve housing or get low-income individuals access to a supermarket in a food desert.
Kaiser Family Foundation points out that definitions of health disparities “health disparities are rooted in the social, economic, and environmental context in which people live” and achieving health equity “will require addressing these social and environmental determinants through both broad population-based approaches and targeted approaches focused on those communities experiencing the greatest disparities.”