In February, CMS released a final report on its Accountable Health Communities model, which launched in 2017 and ran until 2023.
The model focused on addressing “upstream drivers of health,” or social determinants, for Medicaid and original Medicare beneficiaries. These factors included housing, food, transportation, utilities and interpersonal violence. The program connected beneficiaries to relevant community resources in hopes of lowering spending and utilization.
The model’s assistance track randomly offered some beneficiaries navigation services, and all got clinical care and a community referral summary. The alignment track granted these services to beneficiaries without randomization and also had participating organizations carry out community-level activities.
Organizations screened more than 1 million beneficiaries. In the assistance track, both Medicare and Medicaid beneficiary total expenditures decreased, along with unplanned inpatient readmissions. Specialist visits also dipped across both groups. For the alignment track, both groups had fewer primary care visits, as well. Across both tracks, the model led to more than $200 million in net savings. As determined by the assistance track, Medicare beneficiaries involved in other alternative payment models saw greater reductions in expenditures and utilization, too.
“We now know that screening for and addressing upstream drivers of health are essential to improve outcomes and reduce unnecessary utilization, but when AHC launched back in May 2017, this wasn’t as obvious of a policy,” Ipek Demirsoy, CMS Innovation Center group director of state and population health, said Feb. 23 on LinkedIn. “This model blazed the trail for so many other pilots, initiatives and start-ups.”
Need-resolution rates were comparable across intervention and control groups for the assistance track, but the report said some subpopulations — such as those with chronic conditions — could have had better outcomes and greater resolution.
“Favorable outcomes were often achieved even when needs remained unresolved. This suggests that navigation itself may be a key mechanism of change,” the report added.
Transportation needs were specifically associated with higher expenditure for Medicare beneficiaries with at least two emergency department visits, whereas multiple needs were linked to higher expenditure for those with Medicaid. Some state Medicaid programs may cover nonemergent medical transportation services, unlike Medicare.
“[Fee-for-service] Medicare beneficiaries with transportation needs may have a harder time accessing preventive medical care,” the report said. “Poor access to preventive medical care could lead to a heavier reliance on acute and costly medical services, such as hospital care.”
CMS Innovation Center Director Abe Sutton is looking to translate the successes from this model into further discussions on the center’s future.
“In many ways, the Accountable Health Communities [model] was ahead of its time in advancing evidence-based prevention,” Mr. Sutton said Feb. 24 on LinkedIn. “Policy makers have asked thoughtful questions about the role the Innovation Center plays. The final evaluation report on the AHC model is worth considering as part of that conversation.”
The Innovation Center decided to end four Medicare payment models prematurely in 2025 and has faced scrutiny over a recent prior authorization approach that would harness AI vendors.
