Abstract
Policymakers, health plans, and provider organizations are aggressively pursuing care delivery and payment reforms in an effort to reduce burgeoning healthcare cost growth and improve health outcomes. Accountable care organizations (ACOs), coupled with capitated payment arrangements, have been billed as the next great hope.
As currently structured, however, most ACOs contain a serious flaw: Although there is now significant evidence of the value of investment in certain social services interventions, the vast majority of ACO financing structures, including most of those promoted by the Centers for Medicare and Medicaid Services (CMS) and state Medicaid programs, carve out the largest drivers of health: social, environmental, and community factors. Predominantly, ACO models focus entirely on traditional healthcare services, even though these services only contribute to a small proportion of an individual’s health.
Insights Results
Overview of model
CCA was an early pioneer in developing fully integrated models that address physical and behavioral health in tandem with social needs
The mission of model is to create “culture of health” through increased investment in social supports – combined with promotion of strong partnerships between traditional healthcare delivery and social services organizations in the form of fully financially integrated delivery systems
Principles of model: 1) Embrace independent living as primary goal; and 2) Person-centered, community-based care for economically challenged populations with significant disease burdens must comprehensively address all challenges, not just medical
Integrates premium dollars into medical, behavioral health, and social (long-term support services) spending (e.g., using medical dollars to pay for air conditioners and prevent asthma in members, medically tailored meals for patients with diabetes)
CCA members are assigned Care Partners, or members who build longitudinal, trusting relationships with members by understanding needs related to social supports and commenting in their care plan
CCA relies heavily on community partners to address patients’ social needs. Developed financial incentives that enable alignment with community partners
Key takeaways/implications
Recommendations for future social ACO models: 1) Train staff to make flexible decisions that support social services and community based care; and 2) Create financial supports at the health system level that allow for flexibility of case managers to spend modest sums for things like transportation and child care
