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This issue brief from ChangeLab describes the legal and practical issues in creating accountable communities for health (ACH), which were part of the proposed California State Innovation Model (SIM).  The issue brief was funded by The California Endowment.

The issue brief identifies community stakeholders, a governing body, a backbone organization, and a wellness fund as the core components of an ACH.  Among the key operating principles for an ACH are neutrality, accountability to the community, flexibility, and sound governance. Among the key design decisions are whether the backbone organization and wellness fund are managed by the same or different organization (and whether they are new or existing organizations), and whether they are non-profit, for profit, or governmental organizations.  These design decisions often will depend in the organizational capabilities (and working relationships) among existing organizations where the ACH will operate.

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.

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