Can engaging patients with social determinants of health (SDOH) and chronic conditions, benefit from engaging with providers and others, in the context of care delivery by accountable care organizations (ACOs) and similar entities? That’s the question that a team of healthcare policy researchers has asked.
The results of their research have just been published online in Health Affairs, in an article entitled “Health Care Impacts Of Resource Navigation For Health-Related Social Needs In The Accountable Health Communities Model.”
The article’s authors—William Parish, Heather Bell, Fang He, Noah D’Arcangelo, Melissa Romaire, Lucia Rojas-Smith, and Susan G. Haber, write in the abstract to their article, published online on May 17, that “Social determinants of health can adversely affect health and therefore lead to poor health care outcomes. When it launched in 2017, the Accountable Health Communities (AHC) Model was at the forefront of US health policy initiatives seeking to address social determinants of health. The AHC Model, sponsored by the Centers for Medicare and Medicaid Services, screened Medicare and Medicaid beneficiaries for health-related social needs and offered eligible beneficiaries assistance in connecting with community services.”
The researchers note that “This study used data from the period 2015–21 to test whether the model had impacts on health care spending and use. Findings show statistically significant reductions in emergency department visits for both Medicaid and fee-for-service Medicare beneficiaries. Impacts on other outcomes were not statistically significant, but low statistical power may have limited our ability to detect model effects. Interviews with AHC Model participants who were offered navigation services to help them find community-based resources suggested that navigation services could have directly affected the way in which beneficiaries engage with the health care system, leading them to be more proactive in seeking appropriate care. Collectively, findings provide mixed evidence that engaging with beneficiaries who have health-related social needs can affect health care outcomes.”
The researchers note that, “To better understand how the health care sector can best identify and address health-related social needs, in 2017 the Center for Medicare and Medicaid Innovation launched a five-year model called the Accountable Health Communities (AHC) Model. The Innovation Center funded thirty-two entities, referred to as bridge organizations, that each targeted a self-identified geographic service area. Under the AHC Model, bridge organizations used the same screening tool to identify Medicaid, Children’s Health Insurance Program (CHIP), and Medicare beneficiaries in their geographic service areas who had one or more core health-related social needs (housing instability, food insecurity, transportation problems, difficulties paying for utilities, and interpersonal violence or safety issues). Bridge organizations partnered with clinical delivery sites, which were required to screen all community-dwelling Medicaid, CHIP, and Medicare beneficiaries seeking care. Medicaid and CHIP beneficiaries were grouped together in this study and are hereafter collectively referred to as Medicaid beneficiaries.”
In the end, they conclude that “Evidence to date on the impact of screening and navigation programs on health care outcomes is mixed. For example, one recent study found that programs in which community health workers play a similar role as navigators in the AHC Model to provide social support, health behavior coaching, connections to community resources, and health system navigation saw statistically significant reductions in hospital use. This is consistent with this study’s finding of reductions in ED use. In contrast, a randomized trial examining patients participating in a high-intensity navigation trial in Camden, New Jersey, did not show cost or utilization impacts.”
And, they add that “This study presented interim results from an independent evaluation of the AHC Model. Data only represent 2.5 years of AHC Model experience for Medicaid beneficiaries and 3.5 years of experience for fee-for-service Medicare beneficiaries. The evaluation is ongoing and will continue to produce estimates of model impact and to explore questions that this study did not answer, such as whether and why there is variation in impact across the bridge organizations that implemented the AHC Model.”
