CMS Innovation Center Launches $157M Pilot Project to Bridge Clinical Care with Social Services

Jan. 6, 2016
The Department of Health and Human Services (HHS) unveiled this week a new $157 million pilot program that will test the viability of focusing on the health-related social needs of Medicare and Medicaid beneficiaries with the overall goal of lowering healthcare costs and improving the quality of care.

The Department of Health and Human Services (HHS) unveiled this week a new $157 million pilot program that will test the viability of focusing on the health-related social needs of Medicare and Medicaid beneficiaries with the overall goal of lowering healthcare costs and improving the quality of care.

The Accountable Health Communities Model is a five-year program under the Centers for Medicare & Medicaid Services (CMS) Innovation Center and marks the first federal effort to focus on social needs as part of healthcare delivery by working to build alignment between clinical and community-based services at the local level. The new model will award grant funding to 44 bridge organizations, which will deploy a common, comprehensive screening assessment for health-related social needs among all Medicare and Medicaid beneficiaries accessing care at participating clinical delivery sites and then connect beneficiaries with local social services.

“We recognize that keeping people healthy is about more than what happens inside a doctor’s office, and that’s why, for the first time, we are testing whether screening patients for health-related social needs and connecting them to local community resources like housing and transportation to the doctor will ultimately improve their health and reduce the cost to taxpayers,”  HHS Secretary Sylvia Burwell said in a statement. “The Accountable Health Communities model is yet another step towards building a health care system that results in healthier people and stronger communities and spends our health care dollars more wisely.”

The overall goal is to test whether screening beneficiaries for health-related social needs and associated referrals to and navigation of community-based services will improve quality and affordability in Medicare and Medicaid. Social issues such as housing instability, hunger and interpersonal violence can affect individuals’ health, yet they may not be detected or addressed during typical healthcare-related visits.

“ Over time, these unmet needs may increase the risk of developing chronic conditions and reduce an individual’s ability to manage these conditions, resulting in increased health care utilization and costs,” HHS stated in a press release. “The goal of this model is that beneficiaries struggling with unmet health-related social needs are aware of the community-based services available to them and receive assistance accessing those services.”

The bridge organizations will oversee the screening of Medicare and Medicaid beneficiaries for social and behavioral issues, such as housing instability, food insecurity, utility needs, interpersonal violence, and transportation limitations, and help them connect with and navigate the appropriate community-based services.

“For decades, we’ve known that social needs profoundly affect health, and this model will help us understand which strategies work to help improve health and spend dollars more wisely,” Patrick Conway, M.D., CMS deputy administrator and chief medical officer, said in a statement. “We will learn how health and health care improvements can be achieved through strong partnerships and linkages at the community level.”

This initiative reflects the federal government’s broader strategy to shift the healthcare industry toward value-based payment models. In January 2015, HHS announced, as reported by Healthcare Informatics, an ambitious goal to tie 30 percent of traditional Medicare fee-for-service payments to quality and value through alternative payment models, such as an Accountable Care Organization (ACOs), by the end of this year and 50 percent of those traditional fee-for-service Medicare payments tie quality-driven, value-based reimbursement models by 2018. And, the goals for all traditional Medicare payments are even higher. By 2016, HHS aims to have 85 percent of all traditional Medicare payments tied to quality and value and 90 percent by 2018.

As HCI Editor-in-Chief Mark Hagland noted in a blog post about the HHS announcement last January, “Even the leaders of those patient care organizations on the leading edge of change—integrated health systems aggressively pursuing population health management, ACO, bundled-payment, patient-centered medical home, and other strategies—are reporting that the current landscape is a challenging one for them. Of course it is: moving from operations based on volume to operations based on value is a fundamental shift. And until recently, nearly every incentive in healthcare encouraged core volume-based effort and activity.

“So it’s time for anyone in the industry who still doubts the essential federal policy and reimbursement direction to see the light here and get with the program, basically. Because if ever there were a signal to healthcare providers about policy direction, this is it,” Hagland wrote last January.

In a release about the new pilot program, HHS wrote, “The Affordable Care Act provides tools, such as the Accountable Health Communities Model, to move our health care system toward one that rewards doctors based on the quality, not quantity of care they give patients. Today’s announcement is part of the Administration’s broader strategy to improve the health care system by paying providers for what works, unlocking health care data, and finding new ways to coordinate and integrate care to improve quality.”

According to HHS, more than 4,600 payers, providers, employers, patients, states, consumer groups, consumers and other partners have registered to participate in the Health Care Payment Learning and Action Network, which was launched to help the entire health care system reach these goals.

Regarding the Accountable Health Communities model, the program will test three scalable approaches to addressing health-related social needs and linking clinical and community services – community referral, community service navigation, and community service alignment. The pilot allows participants to assess community services and encourage partner alignment to ensure these services are available and responsive to the needs of beneficiaries. This continuous quality improvement approach includes organizing an advisory board and data sharing to inform a gap analysis and quality improvement plan, HHS said.

To measure the effectiveness of the model on impacting total cost of healthcare utilization and quality of care, the primary evaluation will focus on reduction in total healthcare costs, emergency department visits, and impatient hospital readmissions, according to HHS.

Eligible applicants for the Accountable Health Communities model are community-based organizations, hospitals and health systems, institutions of higher education, local government entities, tribal organizations, and for-profit and not-for-profit local and national entities with the capacity to develop and maintain a referral network with clinical delivery sites and community service providers.

Applications will be due in early 2016 and CMS anticipates announcing awards in the fall of 2016.

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