CMS Picks 32 Organizations to Test New Community Health Model

National initiative seeks to lower health care utilization and costs

Last year, the Centers for Medicare and Medicaid Services (CMS) announced applications for the Accountable Health Communities (AHC) model. Over a five-year period, the 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.

The CMS has now chosen the participants for two of the AHC model’s three tracks––the assistance track and the alignment track. By addressing critical drivers of poor health and high health care costs, the model aims to reduce avoidable health care utilization, lower 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 and Quality.

After a review process, the CMS chose 12 assistance-track and 20 alignment-track bridge organizations representing rural and urban communities in 23 states to participate in the model. The 32 organizations include county governments, hospitals, universities, and health departments.

The following are two examples of how AHC bridge organizations will operate.

  • In the AHC assistance track, the Community Health Network Foundation in Indianapolis, Indiana, will partner with the Eastside Redevelopment Committee, a group 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 where the emergency-room utilization rate is above the national average. Through their participation in the AHC assistance track, the two groups hope to reduce health care costs for high-risk beneficiaries who receive navigation services.
  • In the AHC alignment Track, the Oregon Health & Science University (OHSU) will seek to reduce health care utilization and the cost to beneficiaries in nine rural counties in Oregon by working with more than 50 clinical sites, community service providers, and local health departments. In Oregon, the AHC model targets more than 300,000 Medicare and Medicaid beneficiaries. OHSU will coordinate the model activities through the Oregon Rural Practice-Based Research Network, which consists 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 AHC model will begin on May 1, 2017, with a five-year performance period.

Source: CMS; April 6, 2017.