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CMS Accountable Health Communities Model Stresses Social Needs

A new program from CMS called the Accountable Health Communities Model brings more focus on addressing social needs of Medicare and Medicaid beneficiaries.

By Vera Gruessner

This past January, the Centers for Medicare & Medicaid Services (CMS) announced a new funding opportunity for a program called the Accountable Health Communities (AHC) Model, which focuses solely on the social needs of Medicare and Medicaid beneficiaries. These issues may delve into housing problems, lack of food, and whether or not physical abuse has taken place. Social issues are rarely discussed during a doctor visit and this new model may change such missed opportunities, reports The CMS Blog.

 Accountable Health Communities Model

The reasoning behind the Accountable Health Communities Model is due to research showing that, when social needs are met, healthcare costs decrease and patient outcomes improve.

CMS is currently making modifications to the Track 1 application mandates and releasing more specific requirements for applying to the Accountable Health Communities Model. One of the changes includes decreasing the number of screened beneficiaries needed to participate in the program from 75,000 to 53,000.

Additionally, CMS is looking to boost the funding available for each recipient from $1 million to $1.17 million across a five-year time period. Among participating facilities, Medicare patients will be given more information through greater screening, dissemination of resources, and referrals. Many clinics lack awareness of community service facilities that could assist their patients and the Accountable Health Communities Model incentivizes providers to change this behavior.

The Accountable Health Communities Model is meant to bring greater awareness to the decreased ability of medical facilities to address health-related social needs due to a general lack of universal screening and the unacknowledgement among patients and providers about community service resources that could assist in meeting these social needs. The Track 1 program will gear more resources towards managing population health on a level that addresses social needs.

READ MORE: AHA Questions CMS Medicare Advantage Risk Score Calculation

Track 1 participants will have the chance to work with their local state Medicaid agencies to implement the Accountable Health Communities Model. According to a CMS factsheet, healthcare costs often go beyond that of typical medical intervention and incorporate the costs associated with growing social needs.

Unmet nutritional needs and housing instability could all lead to more exacerbated chronic medical conditions, which would increase healthcare spending as a whole. For example, patients may be less able to manage their chronic conditions including being able to afford medications when their housing is unstable.

Track 1 of the Accountable Health Communities Model will be a way to test whether tracking and addressing social needs will reduce healthcare utilization and spending. Based on the CMS factsheet, some of the areas in which clinics will provide community resources include food insecurity, housing instability, utility needs, and transportation outside of medical transportation.

First, clinicians will need to do a complete inventory of all community resources available to meet social needs throughout their local neighborhoods. The next step is to incorporate universal screening of all Medicare and Medicaid beneficiaries seeking their healthcare services to determine whether or not any social needs must be met.

The last step clinicians will need to take is to refer their patients to community centers that are able to assist in meeting their “health-related needs” using intervention groups that will ensure these patients will obtain the help they require.

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“Under this announcement, CMS is accepting applications from community-based organizations, health care practices, hospitals and health systems, institutions of higher education, local government entities, tribal organizations, and for-profit and non-for- profit local and national entities with the capacity to develop and maintain relationships with clinical delivery sites and community service providers,” Patrick Conway, M.D., CMS Principal Deputy Administrator and Chief Medical Officer, wrote for The CMS Blog. “Applicants from all 50 states, U.S. Territories, or the District of Columbia (D.C.) may apply.”

CMS and the healthcare industry is bringing continued focus toward reducing the growing medical costs seen around the country. Whether or not addressing social needs will cut down on healthcare spending remains to be seen, but a general aim toward value-based care reimbursement may be incentivizing physician practices and hospitals to reduce overuse of testing and wasteful spending.

“Alternative payment models generally make doctors and hospitals attentive to the total costs of treating a patient at a high level of quality, giving clinicians the opportunity to focus on quality, patient-centered care,” Jeff Rivkin, Research Director for Healthcare Payer IT Strategies at IDC Health Insights, told

“This is prevalent because Medicare has established official value-based care reimbursement goals by the end of year 2016 and 2018. In 2011, Medicare made almost no payments to providers through alternative payment models, but today, such payments represent approximately 20 percent of Medicare payments.”

Value-based care payments aimed at improving patient safety and outcomes is likely to benefit Medicare and Medicaid beneficiaries for years to come.

READ MORE: APMs, Health Data Exchange among Top Payer Reform Goals


Dig Deeper:

How Payers Should Prepare for Value-Based Reimbursement

CMS Reveals 4 Options for Quality Payment Program Participation


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