Strong financial leadership is likely key to the success of accountable communities for health

• Accountable communities for health (ACH) are models of care that form integrated networks of healthcare providers and community organizations to develop a systematic approach for addressing the health and social needs of patients.
• Going beyond providing treatment of disease, ACH’s target some of the underlying causes of poor health, including social determinants such as nutrition, housing, transportation and employment.
• Financing of ACH’s can come from multiple sources, often requiring start-up funds and a combination of public and private grants, loans, investments and other sources to sustain the program.

Accountable communities for health (ACH) are models of care that form integrated networks of healthcare providers and community organizations to develop a systematic approach for addressing the health and social needs of patients. Through better alignment, these networks become accountable for the overall health of the patient.

Going beyond providing treatment of disease, ACH’s target some of the underlying causes of poor health, including social determinants such as nutrition, housing, transportation and employment.

Each ACH is anchored by a lead organization that facilitates care coordination and data sharing, with a goal to lower total cost of care in the community. The Centers for Medicare and Medicaid Services (CMS) funds 30 Accountable Health Communities through its Innovation Center, and there are a number of other similar models throughout the U.S.

Financing of ACHs can come from multiple sources, often requiring start-up funds and then a combination of public and private grants, loans, investments and other sources to sustain the program. In a recent Health Affairs article, researchers provide an analysis that details sources of funding available for ACH infrastructure, noting that often funding is focused on the programs and services of the ACH rather than supporting a robust infrastructure necessary for operation and non-programmatic functions. The analysis uncovered a significant number of funding opportunities, including:

• Public health and social services (e.g., agencies such as the Administration for Children and Families, Centers for Disease Control and Prevention, Substance Abuse & Mental Health Services Administration)
• Public insurance programs (e.g.,  Medicaid, Medicare and Marketplace)
• Private and philanthropic initiatives (e.g., private grands, social impact bonds)

And many of these sources ranked as strong opportunities.

However, the analysis also highlights the complexity in funding ACH programs, particularly for infrastructure costs — with each funding source having its own eligibility and implementation requirements, depending on programs offered, population served and organizations involved. And to fully fund ACH efforts as well as to support the program, there also is a need for braiding funds — which coordinate distinct funding sources or blending funds — which pool multiple sources.

Takeaway

Several policy recommendations are made by the authors of the Health Affairs aticle to incorporate infrastructure support into future funding streams for ACHs and continued research on developing strong and sustainable ACH programs. Likely the success of these programs also includes strong financial leadership to manage and source the complex funding and ensure the long-term financial sustainability of these important programs.