AMCs, Teaching Hospitals Stand to Gain Under New CMS Model

This blog post was written by Michelle Wilkinson, Manager, and Emma Mandell Gray, Senior Manager.

Last month, the Centers for Medicare & Medicaid Services (CMS) announced a new initiative geared toward improving healthcare delivery. The Accountable Health Communities (AHC) model attempts to bridge a critical gap between clinical care and community and social services by screening Medicare and Medicaid beneficiaries for certain health-related social needs in the core areas of housing, food, utilities, interpersonal violence, and transportation. CMS’s goal is to ultimately improve overall care and health outcomes by steering patients to the appropriate community resources available to them.The AHC model is a 5-year program, with organizations applying for and participating in 1-year renewable agreements in one of the following three tracks:

  • Track 1 aims to increase beneficiary awareness of available community services through information dissemination and referral. Twelve organizations will be selected to participate, and each can earn up to $1 million in incentives.
  • The objective of Track 2 is to provide community service to assist high-risk beneficiaries with access. Up to $2.57 million will be awarded to each of 12 participating organizations.
  • In Track 3, organizations will encourage partner alignment to ensure that community services are available and responsive to the needs of beneficiaries. Twenty organizations will be selected for this track, and each stands to earn up to $4.51 million.

Track 1, 2, or 3?

AMCs and teaching hospitals are eligible to participate in any of the three tracks. However, Track 1 is particularly relevant for these organizations, given their emphasis on education and innovation. Specifically, learners and faculty can serve as a resource to pilot and implement interventions to raise awareness and then study the results.  Developing an understanding of community resources and sharing this information with patients will not only benefit the patients, but will also ensure that the learners themselves are considering the holistic needs of the patient, which will serve them well as independent practitioners in the future.

Benefits of the AHC Model

Regardless of the track selected for participation, AMCs and teaching hospitals can further benefit from participation in this new program because the model:

  • Offers an improved approach to managing the health and costs of uninsured and underinsured patients, a population that typically has a higher demand for community and social services.
  • May improve patient compliance and outcomes, as care plans will incorporate environmental and socioeconomic pressures placed on the patient. Understanding and accounting for these factors can result in efficiencies in care and costs.
  • Teaches learners population health management techniques and more innovative and comprehensive models of care.
  • Provides an opportunity for scholarship, quality improvement, and population health research for residents, faculty, and other learners.

AMC and teaching hospital participation in an AHC also has broader benefits for the community. These organizations can help manage patients in collaboration with community providers, share best practices, and provide linkages to innovative strategies, research, and care delivery models.

CMS has strongly encouraged interested organizations to submit a nonbinding letter of intent by February 8, 2016, and applications to participate are due on March 31. Additional information about the AHC model can be found here, along with a readiness assessment to help organizations determine which track is best for them.

This entry was posted in AMC, Care Model, CMMI, Integration, Patient-Centered Care and tagged , , , , , , , , by Michelle Wilkinson. Bookmark the permalink.

About Michelle Wilkinson

As a member of ECG’s Academic Healthcare Division, Michelle focuses on addressing those healthcare issues related to the tripartite mission of educational, clinical, and research enterprises. At ECG, Michelle has assisted clients with a variety of projects, including strategic planning, financial modeling, and alignment/integration. Most recently, she has served in an interim management capacity to develop the infrastructure necessary to support a centralized academic affairs function for a multistate community academic health system. Michelle also has experience in the Lean methodology and is a certified Six Sigma Green Belt. She has led cross-functional teams in process redesign and curriculum development. Prior to joining ECG, she completed an administrative fellowship at UNC Health Care System, focusing her efforts on program planning. Michelle holds a master of science degree in public health, with a concentration in health policy and management, from The University of North Carolina at Chapel Hill and a bachelor of arts degree in environmental science and public policy, with a focus in health policy, from Harvard University.

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