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Evaluating the Accountable Health Communities (AHC) Model


  • Can identifying—and treating—health-related social needs reduce health care costs and utilization?
  • Abt is using a mixed methods approach to evaluate AHC implementation and outcomes.
  • Results are expected to emerge in 2020.
The Challenge

CMS launched the Accountable Health Communities (AHC) Model to address the gap between clinical care and community services in the health care system. The AHC Model is based on emerging evidence that addressing health-related social needs can improve health outcomes. Abt, as a sub-contractor to RTI, is testing whether systematically identifying and addressing the health-related social needs of Medicare and Medicaid beneficiaries’ through screening, referral and community navigation services will impact health care costs and reduce health care utilization.

The Approach

The AHC evaluation is using a mixed methods approach to describe AHC communities and to gather data from model implementers and the Medicare and Medicaid beneficiaries they serve. Abt’s main responsibilities within the evaluation include delivering community profiles, a beneficiary survey and interviews with—and a survey of—community service providers. Other parts of the evaluation include claims analyses, interviews with other stakeholders and a network analysis that seeks to understand the relationships between stakeholders.

The Results

The beneficiary survey will be fielded in early 2020. The Community Service Provider interviews are scheduled to begin at the end of January 2020 and the Community Service Provider survey will be fielded in the summer of 2020.