CMS unveils care model linking social needs, healthcare

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A new care model from the Centers for Medicare & Medicaid Services will zero in on social health-related needs such as food insecurity or unstable housing.

The Accountable Health Communities Model will examine whether pinpointing and addressing these needs can help improve outcomes, reduce costs and decrease the risk of developing a chronic condition. The model may have particular interest for nursing homes accepting dual eligibles or seniors in need of financial assistance.

CMS will implement and test the model over five years, with three tracks of “varying intensity” aimed at closing a “critical gap between clinical care and community services,” the agency said. Among the tracks is a community referral approach, which link local organizations and agencies to provide care planning and follow-up for beneficiaries.

Hospitals, healthcare provider practices, local governments and for- and not-for-profit health systems are eligible to apply for the test. Successful applicants will receive one of 44 cooperative agreements, ranging from $1 million to $4.5 million.

“For decades, we've known that social needs profoundly affect health, and this model will help us understand which strategies work to help improve health and spend dollars more wisely,” said CMS Deputy Administrator and Chief Medical Officer Patrick Conway, M.D. “We will learn how health and healthcare improvements can be achieved through strong partnerships and linkages at the community level.”