A new screening program available to eligible Medicare and Medicaid patients of Waianae Coast Comprehensive Health Center, Kalihi-Palama Health Center and The Queen’s Medical Centers aims to address critical gaps between clinical care and social services. Funded by a five-year, $4.5 million award from the Centers for Medicare & Medicaid Services (CMS) to UnitedHealthcare, in partnership with the Hawaii State Department of Human Services, the Accountable Health Communities (AHC) model was created by CMS’ Center for Medicare and Medicaid Innovation (CMMI).
UnitedHealthcare has implemented the Accountable Health Communities Model, which includes self-administered screenings – completed by using a computer tablet – to help identify and address the health-related social needs of eligible Medicare and Medicaid recipients, thereby improving their experiences and reducing inpatient and outpatient utilization, while reducing total health care costs. These health-related social needs can include employment, safe housing, reliable transportation and financial stability. The award to support program activities was provided to UnitedHealthcare; however, patients do not need to be enrolled in a UnitedHealthcare Medicare or Medicaid managed care program to participate. UnitedHealthcare is further supporting the program with an additional $6.4 million investment.
“Social barriers, such as housing instability and quality, food insecurity, personal safety, and lack of transportation and affordable utilities, affect people’s ability to maintain their health and well-being,” said Katherine Keir, UnitedHealthcare Hawaii state director. “This award will enable UnitedHealthcare and our clinical partners to identify the needs of some of our most vulnerable residents and connect them to community-based organizations that can help them live healthier lives.”
In addition to the partner clinical sites, several community-based organizations are working to implement the program. These include Aloha United Way, The Institute for Human Services, Catholic Charities Hawaii, Child & Family Service, Parents and Children Together and Hawaiian Community Assets.
The award also funds a team of navigators who will assess the results of the screenings, make referrals, coordinate services and perform ongoing follow-up to help resolve an individual’s social needs. Since October 2018, the clinical partners have offered the comprehensive screening to more than 7,700 Medicare and Medicaid recipients. The goal is to reach 75,000 comprehensive screenings per year.
An advisory board of local stakeholders helps oversee program implementation, encourage partner participation, ensure that social services are available and aligned to patients’ needs, and assess the results of the model. The advisory board includes representatives from the Governor’s office, DHS Med-QUEST administration, state government agencies, health care providers and social service organizations.
The project described was supported by Funding Opportunity Number CMS-1P1-17-0010 from the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.
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