Healthcare researchers have known for years that social determinants are a major influence on healthcare outcomes and costs. Now, players and payers on the ground are starting to catch on.
The CMS said Thursday it was tweaking one track of its Accountable Health Communities model, aimed at addressing social determinants of health, to make it available to a broader swathe of applicants. The changes increased the maximum amount of funding available to recipients and lowered the number of beneficiaries they'd be required to screen.
“We are encouraged by the willingness of CMMI to listen to the community's concerns regarding the limitations of their original requirements and to make adjustments to ensure that the model is ultimately successful,” Jason Gromley, the vice president of operations for the Root Cause Coalition, a not-for-profit that works to address health disparities. By loosening the requirements, more organizations would be enticed to apply to participate in the model, he said.
The CMS first announced the Accountable Health Communities Model in January. It was the first-ever model from Center for Medicare & Medicaid Innovation to target the health-related social issues of Medicare and Medicaid beneficiaries.
That social determinants affect health is well established.
The World Health Organization has described these non-clinical factors as “the conditions in which people are born, grow, live, work and age,” which in turn “are shaped by the distribution of money, power and resources at global, national and local levels.”
In CMS' Accountable Health Communities model, a slew of different organizations, including community-based organizations, healthcare groups, hospital systems, higher education institutions and government groups could apply to take part in one of three tracks, with increasing intensities of interventions.
Now, it has expanded Track 1, which has the most limited interventions of the three tracks. That track aims to make patients more aware of community services at their disposal by screening them, giving them information, and referring them.
Applicants for Track 1 were initially required to screen 75,000 beneficiaries per year for social needs. The new requirements lower that to 53,000. The new funding opportunity also raised the maximum amount of funding organizations could receive from $1 million over 5 years to $1.17 million.
The increase in funding would help reduce the cost to organizations of participating in the AHC model, Gromley said. Lowering the number of beneficiaries they had to screen would also make participating in the model “more manageable,” he added.
The idea is that by addressing the social determinants of health, these models will help people become healthier, while reducing healthcare costs, wrote Dr. Patrick Conway, CMS' principal deputy administrator and chief medical officer, in a blog post Thursday. “Many of these social issues, such as housing instability, hunger, and interpersonal violence, affect individuals' health, yet they are rarely, if ever, detected or addressed during typical health care-related visits.”
