Despite Complex Questions, Bundled Payments for Maternity Care Gains Attention

The best medical care might not be enough to resolve a health issue if the patient does not have the resources for home care follow-through. The Centers for Medicare & Medicaid Services (CMS) is well aware of this potential disparity between healthcare facility and home, and it is promising more than one hundred million dollars to explore ways to secure brighter outcomes for patients once they leave their provider’s office.

Innovation Center commits to over $100 million over five years

Earlier this month, the CMS’s Innovation Center pledged $120 million, over a five-year period, to more than two dozen groups that have been chosen as participants in the agency’s Accountable Health Communities (AHC) model. The goal of the working model is to assist Medicare and Medicaid enrollees in improving ongoing life situations or tasks that lay the foundation to good health, like reliable accessibility to food, housing stability and personal safety within the home, and transportation that goes beyond getting to and from the doctor or clinic.

In the words of the CMS: “T

he foundation of the Accountable Health Communities Model is universal, comprehensive screening for health-related social needs of community-dwelling Medicare and Medicaid beneficiaries accessing health care at participating clinical delivery sites.”

Although the model itself was announced more than a year ago, the participating organizations were chosen from a pool of applicants late in 2016. Those selected include organizations at the level of government, such as the Baltimore City Health Department and the Denver Regional Council of Governments, as well as healthcare or research entities like Oregon Health and Science University, Yale-New Haven Hospital in Connecticut, and Hackensack University in New Jersey.

Awareness, assistance, alignment

The AHC model is comprised of three tracks:

The first, “Awareness Track,” seeks to disseminate beneficial information to Medicare and Medicaid beneficiaries about community services that are available to them. The purpose of the second, “Assistance Track,” is to help “high-risk beneficiaries” access appropriate services. And the third, “Alignment Track,” focuses on making sure that those services remain “available and responsive” to patients’ needs.

The AHC model will serve as a large-scale test of ways of bridging the gap between healthcare setting and home setting as the participants strengthen connections between community and clinic. As the tracks reflect, duties of the organizations will include assessing when Medicare and Medicaid enrollees have health-related social needs that are not being met, and directing them to services that can fill the gap, or going a step further and assisting them in understanding, accessing, and taking part in those services. Patients experiencing shortages of food, unstable housing, or violence within the home obviously will find it difficult or impossible to follow-through on doctor instructions or perhaps to even know when a visit to their practitioner is called for.

Meeting success in this area would be a win-win for the patients (in the form of better post-healthcare results, and therefore improved quality of life) and for the government (in the case of reduced spending due to fewer avoidable or unnecessary visits to a practitioner). As the CMS states on its website, “The Accountable Health Communities Model is based on emerging evidence that addressing health-related social needs through enhanced clinical-community linkages can improve health outcomes and reduce costs.”

Awareness track award recipient announcement forthcoming

Although the CMS did not

share how it plans to exactly divvy the funds up among all 32 participating entities, it did disclose a rough idea. The agency plans to grant up to $4.51 million to each of the 20 grantees slated for the alignment track and up to $2.5 million to each of the dozen organizations in the assistance track. The awareness track has not yet been finalized; the CMS says that it intends to announce the participants in that track at some point this summer, and expects that 12 chosen entities will be each granted up to $1 million.


This blog post is provided for educational purposes only and is not offered as, and should not be relied on as, legal advice. Any individual or entity reading this information should consult an attorney for their particular situation. For more information/questions regarding any legal matters, please email or call 310.203.2800.