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Innovation Models

Accountable Health Communities Model

  • The Accountable Health Communities demonstration program was authorized under section 1115A of the ACA, and is implemented by the Center for Medicare and Medicaid Innovation (CMMI). The model aims to test whether systematically identifying and addressing the health-related social needs of Medicare and Medicaid beneficiaries through screening, referral and community navigation services will impact health care costs and reduce health care utilization. However, CMS has clarified that funds for this model support the infrastructure and staffing needs of the bridge organizations, and do not pay directly or indirectly for any community services (such as housing, food, etc.). The model provides funding to entities across the U.S. the support the following:
    • Screening of community-dwelling beneficiaries to identify unmet health-related social needs
    • Referral of community-dwelling beneficiaries to increase awareness of community services
    • Provision of navigation services to assist high-risk community-dwelling beneficiaries with accessing community services; and
    • Encouragement of alignment between clinical and community services to ensure that community services are available and responsive to the needs of community-dwelling beneficiaries.
  • The Assistance Track provides community service navigation services to assist high-risk beneficiaries with accessing services. The Alignment Track encourages partner alignment to ensure that community services are available and responsive to the needs of beneficiaries. The Assistance and Alignment tracks began on May 1 2017 with a five-year performance period. There are currently 32 organizations participating in the model
  • NASHP has developed an issue brief describing the efforts in several states to implement the Accountable Health Communities model.
  • In January 2018, CMS released a Health-Related Social Needs Screening Tool as part of the Accountable Health Communities model, in order to test whether “finding and dealing with the health-related social needs of Medicare and Medicaid beneficiaries has any effect on their total health care costs and makes their health outcomes better.”

State Innovation Models (SIMs)

  • The State Innovation Models (SIM) are authorized under section 1115A of the ACA and are implemented by CMMI. CMMI partners with states to help to advance state-based multi-payer health care payment and delivery system reform models. CMMI provides federal grants to states, under cooperative agreements, to design and test innovative, state-based multi-payer healthcare delivery and payment systems.Through two rounds of funding, SIM has supported model “test” awardees and model “design” awardees by providing funding, learning tools, and expert technical assistance. Several states received funding for integration of health and social services through SIM models. For example:
    • Arkansas received $42M for a model based on PCMH and additional Health Homes to coordinate medical, community, and social support services for individuals with complex or special needs.
    • Maine received $44M, part of which is funding the development of Certified Community Partners, which are community-based organizations with expertise in delivering care to members with behavioral health, long-term support services, and social service needs.
    • Minnesota received $45M for the creation of Accountable Communities for Health that integrate medical care with behavioral health services, public health, long-term care, social services, and other forms of care.

Medicaid Innovation Accelerator Program (IAP)

In 2014, CMS launched the Medicaid Innovation Accelerator Program (IAP) with the goal of improving health and health care for Medicaid beneficiaries by supporting states’ ongoing efforts related to payment and delivery system reforms. It is intended to help state Medicaid programs build capacity in key program and functional areas by offering targeted technical support, tool development, and cross-state learning opportunities.IAP has four priority program areas: substance use disorders, beneficiaries with complex care needs and high costs, community integration through LTSS, and physical/mental health integration. Through the IAP, CMS offers program support to states to support housing-related services and partnerships as well as improvements in quality and outcomes in community-based LTSS program. IAP works with other relevant agencies on planning and coordination of program support in order to help promote partnerships between state Medicaid agencies, state housing finance agencies, public housing agencies, state and local services agencies, and providers.