CMS to test whether addressing beneficiaries' housing, food needs improves their health

Program is scheduled to launch in early 2017

HHS on Tuesday unveiled a five-year grant program intended to test whether addressing Medicare and Medicaid beneficiaries' nonmedical needs can help to improve such individuals' health outcomes and curb health care spending.

The pilot program, called the Accountable Health Communities Model, will provide $157 million in funding under the Affordable Care Act (ACA) to "bridge organizations" that will work with Medicare and Medicaid beneficiaries to identify the individuals' social needs and connect them with appropriate services. Organizations eligible to apply for the program include:

  • Academic institutions;
  • Community-based groups;
  • Health systems and hospitals;
  • Local governmental entities;
  • Local and national entities that can develop referral networks between clinical delivery sites and community service providers; and
  • Tribal organizations.

Hospitals try to solve life-or-death puzzle: What do you do when patients don't have a ride?

The program will include three tracks:

  • 12 clinical delivery sites that will provide screening and referral services for Medicare and Medicaid beneficiaries;
  • 12 participants that will provide community navigation services; and
  • 20 participants that will provide navigation, referrals and screening services, as well as build partnerships that to help ensure community needs are met over time.

CMS will accept applications for the program until Feb. 8. Grant recipients will be announced in the fall, and the program's initiatives are set to begin in early 2017.

Darshak Sanghavi, director of the Preventive and Population Health Care Models Group at CMS' Innovation Center, says the agency will assess the pilot program's performance by looking for correlating reductions in health care costs, hospital readmissions, and ED readmissions.

According The Hill, the program could be expanded if it helps to improve health care outcomes and reduce spending. Further, officials said the pilot could be incorporated into other ACA initiatives, such as Accountable Care Organizations (Alonso-Zaldivar, AP/Sacramento Bee, 1/5; Sullivan, The Hill, 1/5; Ross Johnson, Modern Healthcare, 1/5; CMS program page, accessed 1/7).

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