CommonSpirit launching outcome-based healthcare model in 6 underserved communities

The COVID-19 pandemic laid bare health inequities throughout the nation and the stark differences in healthcare access across communities.

To address those inequities, Chicago-based CommonSpirit Health is partnering with the Pathways Community HUB Institute to implement a community-centric care navigation model in six communities nationwide.

Ji Im is senior director of community and population health at CommonSpirit, the nation's largest provider of services to Medicaid beneficiaries. She told Becker's the new partnership will connect healthcare and social care by "meeting people where they are" and allow organizations within a community to align care outcomes with cost savings.

"We've decided to partner with PCHI specifically because there was one piece to it: It really leveraged our knowledge of the work that we've been doing to build community-centric care," Ms. Im said. "The PCHI model is built on a community-initiated network."

The PCHI model has three components: an outcome-based payment model, cross-sector collaboration and cultural diversity in the approach.

The cross-sector collaboration component is designed to allow health systems, payers, public entities and community organizations to identify and reach out to those "greatest at risk" and connect them to social, medical and behavioral interventions and services in their community. Once connected with services, the model can track outcomes and contract with payers to directly tie payment to those outcomes.

A total of 21 interventions, called "pathways," are designed to allow community health workers to mitigate risk by providing whole-person care. Pathways represent the steps needed to remove risk, which could be a lack of housing, employment or subpar access to health services. A pathway is completed once the risk factor is removed. Ms. Im said community health workers can often open access to healthcare for some individuals because they may have a shared experience or background.

"This model specifically absolves many of the challenges that our communities face in order to improve the health of the most underserved population, and they do this by creating an infrastructure for community-based coordination, care coordination, and while complementing this work with the already existing community health initiatives," Ms. Im said.

The outcome-based payment model will create a standardized way for organizations to collect data in their community, Ms. Im said. She also pointed out that 50 percent of community health workers' salaries are directly tied to health outcomes.

"This is the future of payment reform for communities because there has to be a way that community-based organizations get paid for services aside from grant funding," Ms. Im said. "There's truly a completion of work tied to outcomes, tied to payment, that makes this model unique."

Six communities — one each in Washington state, Nevada, Arizona, California, Texas and Nebraska — have been chosen for the new model. Organizational work has begun, and a full launch of the program is expected this winter.

Ms. Im said the six communities are just the start toward building a sustainably funded health infrastructure model for other health systems to consider across the country.

"We don't want to stop here. We initially selected these sites, but we want to do more," Ms. Im said. "And we want to encourage other health systems and other health plans and government agencies to say you guys can catalyze this in your respective communities as well."

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