Evaluating the Accountable Health Communities Demonstration Project

Abstract

Despite substantial evidence documenting the social patterning of disease, relatively little information is available on how the health care system can best intervene on social determinants to impact individual and population health. Announced in January 2016, the Centers for Medicare and Medicaid Innovation's (CMMI) Accountable Health Communities (AHC) initiative provides an important opportunity to improve the evidence base around integrated social and medical care delivery. To maximize learning from this largescale demonstration, comprehensive evaluation efforts should focus on effectiveness and implementation research by supporting local, regional, and national studies across a range of outcomes. Findings from this demonstration could transform how, when, and which patients' health-related social needs are addressed within the health care delivery system. Such findings would strongly complement other initiatives to address social factors outside of health care. A substantial body of evidence links social circumstances to health and longevity. 1-3 Mortality estimates associated with social factors are comparable in magnitude to those associated with myocardial infarction, cerebrovascular disease, or lung cancer. [4][5][6] At the same time, there is national concern about the expense and deficiencies of traditional health care services. 7 Together, these forces are fueling interest in addressing social determinants of health (SDH) within the health care delivery system. While recognizing that work to improve social conditions occurs outside of health care settings, 5 health professional organizations have recommended better integration of medical and social care delivery systems as one part of a comprehensive strategy to identify and address SDH. [8][9][10] Clinical delivery systems are increasingly experimenting with ways to address SDH in the clinical delivery system. 11-13 However, little research has examined whether these efforts improve individual and population health, decrease avoidable utilization, and/or improve revenue under value-based payment systems. 11,12 To respond to the disconnect between this growing interest in addressing SDH in the health care setting and gaps in effectiveness evidence, in January of 2016, the Centers for Medicare and Medicaid Services Innovation (CMMI) announced an initiative to test a new model of care that includes health-based social needs screening and resource navigation for Medicare and Medicaid beneficiaries. 14 The financial investment in the CMMI Accountable Health Communities (AHC) initiative totals $157 million over 5 years and presents an important opportunity to fill evidence gaps.In this article, we outline the CMMI AHC demonstration project and anticipated CMMI evaluation outcomes metrics. We then provide a rationale for examining a wider range of effectiveness and implementation outcomes and highlight opportunities and challenges facing this broader research agenda. This article emerged from a meeting of 25 affiliates (complete list included in the Acknowl...

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