Accountable Health Community Models: What’s the State Role?

With growing recognition that the health care delivery system alone cannot improve population health, there is increasing movement at the state and local levels to create new relationships between systems that focus on traditional health care delivery and those that extend to work, housing, family, and community life.

CMMI recently announced an initiative to test whether an Accountable Health Community model that systematically identifies health-related social needs and connects beneficiaries to services can impact total health care costs, overall health, and quality of care. Although focused at the local level, applicants are required to partner with state Medicaid agencies. This relationship makes sense, as states focus payment and delivery reforms on improving care, reducing costs, and improving health by implementing global or bundled payments and shared savings that provide opportunities for communities to channel resources in new directions (e.g. housing supports, food security).

States can participate in such initiatives by providing flexible funding through value-based payments, data sharing arrangements and expertise. State policymakers, who set policies and develop programs related to housing, transportation, safety, education, economic development, public health, and health care delivery, have significant opportunities to set policies that foster health.

Indeed, some states (California, Colorado, Minnesota, New York, Oregon, Vermont, and Washington state to name a few) are actively promoting or exploring models to integrate public health, social services, and delivery and payment systems, and are developing partnerships needed to make these strategies successful. Sometimes referred to as Accountable Communities for Health, these new models are intended to create community environments that promote health and well-being.

These states are aligning Medicaid delivery system reform efforts with prevention agendas, providing financial incentives to address social needs, developing requirements for provider networks to partner with community organizations and consumers to address locally identified priorities, and creating synergy among programs. They are integrating Community Health Workers (CHWs) into evolving health care systems to facilitate care coordination and enhance access to community-based services.

Some of these initiatives are just getting off the ground, and others already have early results. Oregon, for instance, set up a community prevention grant program that requires joint applications between Coordinated Care Organizations (CCOs) and local public health departments to address community needs identified through local needs assessments. They must address both community and health system interventions. Preliminary results are already available; for example, opiate prevention programs report 877 opiate overdose reversals from community members receiving naloxone and a 29% decrease in heroin-related deaths.

As new models are tested through local innovation, engaging states is equally important in order to ensure an adequate infrastructure that can support sustainability and bring innovative local initiatives to scale to benefit residents no matter where in the state they live. States have opportunities to reach beyond traditional health care system reform initiatives to use their policy levers and system changes to address social determinants of health and strengthen the capacity of communities to create health. To assist state policymakers seeking to maximize their leverage, NASHP has compiled a table of funding sources that state agencies use to address social determinants. Stay tuned as NASHP tracks state-level initiatives that explore and promote ACH developments.