Evaluating the Accountable Health Communities Demonstration Project

Gottlieb L, Colvin JD, Fleegler E, Hessler D, Garg A, Adler N
Source: J Gen Intern Med
Publication Year: 2017
Patient Need Addressed: Patient satisfaction/engagement
Population Focus: Dual eligible, Medicaid beneficiaries
Intervention Type: Partnership, Service redesign
Type of Literature: White

Despite substantial evidence documenting the social patterning of disease, relatively little information is available on how the healthcare 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 large-scale 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 healthcare delivery system. Such findings would strongly complement other initiatives to address social factors outside of healthcare.

Insights Results

Overview of article

  • The article presents an overview of the Center for Medicare and Medicaid Innovation (CMMI)’s AHC model (described elsewhere in the directory) and CMMI’s evaluation outcomes metrics, ultimately recommending that CMMI examine a wider range of effectiveness and implementation outcomes and highlight opportunities and challenges facing this broader research agenda. It is the culmination of a SIREN meeting in which participants identified gaps and evidence regarding the impact of healthcare based interventions addressing social needs and opportunities for evaluation
  • CMMI announced that model performance metrics will be total cost of care (TCOC) and healthcare utilization, including ED, inpatient admissions, readmission, and utilization of outpatient services. It also announced that it would assess provider and beneficiary experience, but it did not specify how

Methods of article

  • SIREN researchers identified other opportunities to maximize learning through CMMI-funded analyses or supplementary local, regional, or national evaluation efforts

Key takeaways/implications

  • Past research suggests that 5 years may be too short a window to see many endpoints in claims data. SIREN encourages several strategies to minimize false-negatives, including incorporating proximal mediating factors that are sensitive to changes in social conditions (e.g., outcomes that capture patient satisfaction, patient referrals, connection to social resources). Additionally, SIREN recommends accounting for different mechanisms through which SDOH impact health. Some SDOH are directly tied to health outcomes (e.g., housing) while others are linked to later health through prolonged exposure (e.g., toxic stress). In order to collect such data efficiently, SIREN recommends funding high-quality local studies in a few AHC markets. Finally, SIREN encourages CMMI not to miss the opportunity to assess provider impact (e.g., burnout)
  • SIREN encourages CMMI to use implementation research to address questions about sustainability and dissemination as well as unintended consequences, including the collateral impacts of routine screening and referrals on community agencies, not just healthcare