The federal government will fund a new program to see whether screening Medicare and Medicaid recipients for health-related social needs--and linking them to needed social services--can reduce healthcare spending.
The U.S. Department of Health and Human Services (HHS) announced Tuesday it will provide up to $147 million to fund a new Accountable Health Communities (AHC) model that will support up to 44 bridge organizations that will conduct the screenings and refer Medicare and Medicaid recipients to clinical and community services.
Hospitals and health systems, colleges and universities, community-based organizations, local governments and for-profit and not-for-profit groups are among those eligible to apply for funding. The Centers for Medicare & Medicaid Services (CMS) will announce the grants this fall.
HHS says it will measure the success of the pilot program based on reduction in total healthcare costs, emergency department visits and inpatient hospital readmissions. The pilot program is slated to run for five years.
The AHC Model will have to overcome challenges that have stymied previous attempts at clinical-community collaborations, CMS officials wrote in the New England Journal of Medicine. Those challenges include:
- Major gaps in the evidence base used to determine what to screen for and to collect data for detecting health-related social needs.
- Wide differentials in community needs and the quality of resources available.
"The AHC model reflects a growing emphasis on population health in CMS payment policy, which aims to support a transition from a healthcare delivery system to a true health system," according to the NEJM article.
Different sites will be able to determine how to intervene, with options including mobile devices, at clinics or through home visits. The model will test community referral, community service navigation and community service alignment.
The Brookings Institution, meanwhile, is looking at how hospitals can be hubs to tackle socioeconomic issues that affect population health, FierceHealthcare previously reported. Under this model, hospitals team with a community group that can connect patients with social and clinical services, tackle issues in public housing and advocate for transitional housing for the homeless, to list some examples. One major challenge: Current compensation models don't provide financial incentives for hospitals to play that role, even though those issues affect hospital bottom lines.
So-called harm reduction centers are a more traditional way for hospitals to partner with groups that tackle problems in at-risk communities, like drug abuse and communicable disease, by distributing needles and condoms. Hospitals can coordinate services with the centers, or place clinical and pharmacy services there to provide direct intervention, as FierceHealthcare previously noted.