We were excited to receive notification of a five-year federal program called the Accountable Health Communities (AHC) Model. This is the first Centers for Medicare & Medicaid Services (CMS) Innovation Center model to focus on the health-related social needs of Medicare and Medicaid beneficiaries, including building alignment between clinical and community-based services at the local level.
The goal of this model is to ensure 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 focus of this grant is encouragingly consistent with the core components of Help Me Grow system building, and thereby validates key concepts embraced by our National Center and affiliates.
For example, the program ensures that screening for health-related social needs is not conducted in isolation. Instead, needs identified through screening are addressed by referral and linkage to community programs and services. Furthermore, a critical element of Help Me Grow system is the emphasis on maintaining an accurate and useful inventory of community resources and support through intensive community service.
With such synergy, the federal call for AHC is best answered through an approach that embraces such Help Me Grow precepts as early detection, referral, and linkage to services.
Is AHC an Opportunity for HMG?
The targeted beneficiaries for this funding opportunity include children and adults covered under Medicare and/or Medicaid. However, the opportunity for child-specific systems to successfully submit competitive proposal is limited in two ways: the required evaluation methodology and the daunting expectations for subject enrollment.
To measure the effectiveness of the model on impacting total cost of health care utilization and quality of care, the primary evaluation will focus on reduction in total health care costs, emergency department visits, and inpatient hospital readmissions. Yet the opportunity for such cost savings within the pediatric population is quite modest. This focus on near-term cost saving also does not reflect the long-term potential for enormous savings across health and social services that will accrue if we address children’s and families’ social needs.
In addition to the limited view of cost savings, most child-specific systems are unlikely to have the necessary scale to reach the requisite screening targets. Applicants must present opportunities to screen at least 75,000 community dwelling beneficiaries per year. Furthermore, efforts to align partners must be capable of reaching 51% of community-dwelling beneficiaries in the geographic target area.
We agree with the analysis of our colleague, Charlie Bruner, that, “Given the size of the geographic area, the specific content of the screen, and the overall wide range and size of the beneficiary base, the funding opportunity announcement is clearly not likely to focus upon the particular and distinct needs and opportunities of the child population that characterize innovations in the field to better respond to social determinants of health.”
Encouraged, Disappointed, and Keeping On
We are encouraged, even gratified, by the announcement’s validation of the relevance and importance of key Help Me Grow concepts and principles. Admittedly, we are disappointed with the lack of apparent opportunity to seek support for child-specific systems that identify needs and ensure the linkage of children and their families to community-based programs and services.
We agree with Bruner that the opportunity, “… is not structured … to expand more focused innovations in … early childhood preventive and developmental practice to improve health trajectories for vulnerable children, where the opportunities for many of the greatest gains to health from responding to social determinants exist.” While the short-term return on investment is admittedly modest, there is no debate as to the long-term savings opportunity accrued by investing in linkage systems that support young children and their families.
We and our colleagues will continue to advocate for support of system building that specifically targets children and families. In the interim, we derive some comfort in CMS acknowleding the critical importance of early detection, referral, and linkage of vulnerable populations to community-based programs and services.