This is the final report submitted to the California Health and Human Services Agency from its work group on accountable communities for health (ACH), part of the design of California’s State Innovation Model (SIM).  The work group was supported with funding from The California Endowment.  Although California did not receive funding from the Centers for Medicare and Medicaid Services (CMS) for the implementation of its SIM, it is expected that the concept of ACHs will continue to be one that California – and potentially other states – seek to implement through other health care reform initiatives and activities.

An ACH should build upon an existing community collaborative or other formalized structure with a history of working together. Moreover, the work group identified six key structural elements of an ACH:

  • Shared vision
  • Leadership
  • Collaboration and partnerships
  • Trusted backbone or integrator organization
  • Data and analytics capacity
  • Wellness Fund

An ACH should seek to align evidence-based interventions across multiple clinical and community domains with regard to a particular chronic disease. Specifically, the work group recommends that an ACH implement a “portfolio of interventions” across all five domains of clinical services, community and social services, clinical-community linkages, environmental interventions, and public policy and systems changes.

The payment reform included as part of an ACH is the creation of a local “wellness fund”. The wellness fund would serve as the vehicle for attracting and blending resources from a variety of organizations and sectors, and aligning them with the goals, priorities and strategies developed by the ACH. The work group envisioned that a portion of an initial grant to establish the ACH would help “seed” the wellness fund, in order to enable the ACH to leverage those resources and attract additional investments. For example, a local community foundation could potentially make a grant to the fund, as could the local health department. Similarly, nonprofit hospitals could contribute a portion of their hospital community benefits toward the fund, and health plans serving the geographic community could similarly make a contribution; other sectors, as well, could make investments to leverage their own funding for greater impact. Another approach would involve some or all of the ACH partners agreeing to voluntarily assess themselves, with assessments based on the overall budget of the member partner.

The wellness fund would support both the backbone organization and those selected interventions that do not have other sources of funding.  However, stakeholders in an ACH also must be committed to pursue a “braiding” strategy to creatively blend existing funding streams to implement the ACH activities.  Ultimately the wellness fund could capture any shared savings for reinvestment, although the specific methods for calculating and capturing shared savings remain challenging.

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