CMS’ Accountable Health Communities Model

CMS’ Accountable Health Communities Model selects 32 participants to serve as local ‘hubs’ linking clinical and community services

Last year, the Centers for Medicare & Medicaid Services (CMS) released a Funding Opportunity Announcement (FOA) for applications for the Center for Medicare and Medicaid Innovation’s (Innovation Center) Accountable Health Communities (AHC) model. Over a five-year period, CMS will implement and test the three-track AHC model to support local communities in addressing the health-related social needs of Medicare and Medicaid beneficiaries by bridging the gap between clinical and community service providers. Social needs include housing instability, food insecurity, utility needs, interpersonal violence and transportation.

Today, CMS has announced the participants for two of the tracks, the Assistance and Alignment Tracks, of the AHC model. By addressing critical drivers of poor health and high health care costs, the model aims to reduce avoidable health care utilization, impact the cost of health care, and improve health and quality of care for Medicare and Medicaid beneficiaries. The organizations in the AHC Assistance Track will provide person-centered community service navigation services to assist high-risk beneficiaries with accessing needed services. The organizations in the AHC Alignment Track will also provide community service navigation services, as well as encourage community-level partner alignment to ensure that needed services and supports are available and responsive to beneficiaries’ needs.

“We know that innovation at the state and community level is essential to improve health outcomes and lower costs. In this model, we will support community-based innovation to deliver local solutions that address a broader array of health-related needs of people across the country,” said Dr. Patrick Conway, CMS Deputy Administrator for Innovation & Quality. “As a practicing pediatrician, I know the power of a model like this to help address the health and social support needs of beneficiaries, and their families and caregivers.”

CMS received applications for the Assistance and Alignment Tracks from a variety of organizations across the country. After a review process, 12 Assistance Track and 20 Alignment Track bridge organizations representing rural and urban communities across 193 counties in 23 states were chosen to participate in the model. The 32 bridge organizations in the AHC model are diverse —varying in type (e.g., county governments, hospitals, universities, and health departments), size, location, and beneficiary demographics.

As two examples of how AHC bridge organizations will operate:

• In the AHC Assistance Track, Community Health Network Foundation in Indianapolis will partner with the Eastside Redevelopment Committee, an organization representing 50 businesses and community-based organizations focused on improving health through high-quality support services, educational programs, and workforce development. Together, they will serve residents of East Indianapolis, a community where 40% of the population received Indiana Medicaid services in 2015 and an emergency room utilization rate above the national average. Through their participation in the AHC Assistance Track, they hope to reduce health care costs for high-risk beneficiaries who receive navigation services.
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• In the AHC Alignment Track, the Oregon Health & Science University (OHSU) will seek to reduce healthcare utilization and cost to beneficiaries across nine rural counties in Oregon by working with over 50 clinical sites, community service providers, and local health departments. In Oregon, the AHC model is targeting over 300,000 Medicare and Medicaid beneficiaries. OHSU will coordinate the model activities through the Oregon Rural Practice-based Research Network, a statewide network of primary care clinicians, community partners, and academicians dedicated to studying the delivery of health care to rural residents and to reducing rural health disparities.

The Assistance and Alignment Tracks of the Accountable Health Communities Model will begin on May 1, 2017 with a five-year performance period.

To view a list of the Assistance and Alignment Tracks bridge organizations in the Accountable Health Communities Model, please visit: https://innovation.cms.gov/initiatives/ahcm.

The Accountable Health Communities Model is authorized under Section 1115A of the Social Security Act, which established the Innovation Center to test innovative payment and service delivery models to reduce Medicare, Medicaid, and Children’s Health Insurance Program expenditures while maintaining or enhancing the quality of beneficiaries’ care.

For more information about the Accountable Health Communities Model, please visit: https://innovation.cms.gov/initiatives/ahcm.