Expect more attention at the federal and state levels
The Centers for Medicare and Medicaid Services (CMS) granted $157 million this year to 32 healthcare organizations in its two-track Accountable Health Communities Model. The five-year demonstration will test innovative payment and delivery models such as becoming a hub to align community organizations or helping patients connect with such organizations. States are pushing value-based reimbursement models for Medicaid amid probable funding changes in 2018 and may look to Section 1115 Medicaid demonstration waivers under the Affordable Care Act (ACA) that let them test models such as pay for performance or accountable care. Providers should brace for more risk sharing for this population, which is disproportionately affected by social disadvantages.
Focus on sustainability
Taking social responsibility has helped some organizations engage, maintain and recruit employees. Eighty-four percent of providers said that workforce development and management is important to their success in the next five years. “The millennial generation wants to help people and feel like they’re making a difference,” said Catherine Hamilton, vice president of consumer services and planning at Blue Cross Blue Shield of Vermont. Conversely, organizations that fail to improve their communities may damage their reputations and bring their not for-profit status into question.
You can’t fix what you don’t know
Seventy-eight percent of provider executives say they lack the data to identify patients’ social needs. While clinicians routinely gather standard demographic information in their electronic health records (EHRs), social and lifestyle information—beyond tobacco and alcohol use—is spottier. Only 4 percent of clinicians responding to an HRI survey said they use community data sets to fill in the blanks. Data sharing partnerships and cross-sector collaborations will be critical to match patients with the support services they need.