Accountable Health Communities

About Accountable Health Communities

Centers for Medicare & Medicaid Services (CMS) selected 32 participants for the Assistance and Alignment Tracks of the Accountable Health Communities (AHC) Model. The CMS grant awardees will implement and test the three track AHC model to support local communities in addressing the health-related social needs of Medicare and Medicaid recipients by bridging the gap between clinical and community service providers. Improving the vital link between clinical and social needs, also known as social determinants of health, means the external factors that contribute to poor health can be addressed, in addition to the clinical healthcare needs.

The grant offers the resources needed to continue to build the infrastructure to expand Health Net as a centralized hub and to foster the growth of established strategic partnerships with the following organizations:

  • Arbor Circle
  • Catholic Charities West Michigan
  • Cherry Health
  • Family Outreach Center
  • Heart of West Michigan United Way
  • Metro Health - University of Michigan Health
  • The Salvation Army Turning Point
  • Spectrum Health and Helen DeVos Children’s Hospital

More information about the Accountable Health Communities Model is available on Centers for Medicare & Medicaid Services website or our press release

How Accountable Health Communities Applies to Michigan

The goal of the project is to test whether 1) providing a systematic process to bridge gaps between clinical and community service providers, AND 2) engaging in a community alignment process will result in better health outcomes and lower costs.
Part of the community alignment process includes implementing a centralized screening system to screen for the following Social Determinants of Health:

  • Housing instability 
  • Utility needs
  • Food insecurity
  • Transportation
  • Interpersonal violence

To learn more about why these Social Determinants of Health were chosen as focus areas, read this article.