AHC in NEJM PDF
AHC in NEJM PDF
AHC in NEJM PDF
of
MEDICINE
Perspective
Accountable Health Communities Addressing Social Needs
through Medicare and Medicaid
Dawn E. Alley, Ph.D., Chisara N. Asomugha, M.D., Patrick H. Conway, M.D., and Darshak M. Sanghavi, M.D.
or decades, experts have described a profound imbalance between public funding of acute medical
care and investments in upstream social and environmental determinants of health.1 By some estimates,
more than 95% of the trillion
dollars spent on health care in
the United States each year funds
direct medical services, even
though 60% of preventable deaths
are rooted in modifiable behaviors
and exposures that occur in the
community.1
Most clinicians are familiar
with the stories behind these
statistics: the child with asthma
whose substandard housing triggers repeated emergency department visits; the patient with repeated visits for severe abdominal
pain caused by her violent home
life; the older adult with diabe-
PERS PE C T IV E
Evaluation strategy
$1 million
$2.57 million
12
Track 3: Alignment
$4.51 million
20
State Medicaid agency; clinical delivery sites; community service providers; local government;
local payers (MA Plans and Medicaid MCOs)
Will a combination of community service navigation (at the individual beneficiary level) and
partner alignment at the community level reduce total cost of care, ED visits, and admissions?
* Tracks are mutually exclusive; communities will be selected to participate in a single track. ED denotes emergency department, MA Medicare Advantage, and MCO managed-care
organization.
12
Intervention components
Required partners
Will increasing awareness of community service availability through information dissemination and referral reduce total cost
of care, ED visits, and admissions?
Track 2: Assistance
Screening, referral, plus community service navigation
Track 1: Awareness
Intervention
Variable
PE R S PE C T IV E
Accountable Health Communities
PERS PE C T IV E
vice capacity, testing the scalability and effectiveness of this backbone structure.
The AHC model reflects a
growing emphasis on population
health in CMS payment policy,
which aims to support a transition from a health care delivery
system to a true health system.
The AHC test will improve our
understanding of whether savings
can materialize when upstream
factors are addressed through
collaboration among stakehold-