This report from the Prevention Institute describes the accountable communities for health (ACH) model (also called accountable care communities) that has been implemented in several locations and is being considered by other states.  The model integrates public health considerations into the accountable care organization model that has been focused on short-term quality improvement and cost reductions.  ACHs integrate medical care, mental and behavioral healthcare, and social service supports with efforts to improve the community conditions that shape health and well-being in a geographical area. Emerging ACHs are using a variety of financing mechanisms, including grants, local government general funds, dedicated taxes, or a portion of Medicaid’s global budget. Healthcare cost savings is seen as a secondary long-term goal that should not be an impediment to fostering collaborative action that can make a difference in the well-being of the community. The key elements of the ACH concept:

  1. Brings together major healthcare providers across a geographic area, and requires them to operate as partners rather than competitors;
  2. Focuses on the health of all residents in a geographic area rather than just a patient panel;
  3. Engages a broad set of partners outside of healthcare to improve overall population health; and
  4. Identifies multiple strands of resources that can be applied to ACH-defined objectives that explore the potential for redirecting savings from healthcare costs in order to sustain collaborative efforts.

The report was commissioned by the Department of Vermont Health Access.  It examines five national sites engaged in activities aligned with ACH principles, then identifies six existing efforts in Vermont that could form the basis of an ACH. This document provides profiles and analyses of these 11 sites, details the core elements of an ACH, and issues a specific set of recommendations for implementing an ACH.

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