http://goo.gl/1yVNYX
The Centers for Medicare & Medicaid Services (CMS) Innovation Center announced the Accountable Health Communities (AHC) model, which recognizes the same “social co-morbidities” that Dr. Geiger attempted to address decades ago. This is the first Innovation Center pilot to address this gap in the current delivery system by funding interventions that connect patients with the resources they need to be healthy. Through this model, CMS has at last recognized a broader and more realistic view of what counts as health care and brought 70 percent of the modifiable factors that influence health back to the table in a meaningful way (social, economic, physical, behavioral).
Historically, patients’ health-related social needs have not been addressed in traditional health care delivery systems. Many health systems lack the infrastructure and incentives to develop systematic screening and referral protocols or build relationships with existing community service providers. The Accountable Health Communities (AHC) model seeks to bridge the divide between the clinical health care delivery system and community service providers to address these health-related social needs.
Mitigating these social co-morbidities means recognizing that access to healthy food or electricity to refrigerate insulin is as relevant to achieving the goals of the Triple Aim as a diagnosis of obesity and diabetes. Specifically, the AHC model is based on growing evidence that addressing social co-morbidities through effective clinical community links can improve health outcomes (by mitigating the root causes of disease) and reduce cost (largely by reducing utilization of clinical health resources).