Evaluation finds AHC model saved more than $200 million in health costs

RTI evaluated the effects of the Accountable Health Communities Model (AHC), which reached more than 1 million Medicare and Medicaid beneficiaries

RESEARCH TRIANGLE PARK, N.C. — An evaluation led by the independent scientific research institute RTI International found that the Centers for Medicare & Medicaid Services’ (CMS’) Accountable Health Communities (AHC) Model generated more than $200 million in net savings while reducing inpatient stays and emergency department visits among Medicare and Medicaid beneficiaries.

The AHC Model, launched by the Center for Medicare and Medicaid Innovation in 2017, tested whether the quality and cost of care could be improved by screening and connecting beneficiaries to resources to address five core needs:

• Housing instability
• Food insecurity
• Transportation problems
• Utility difficulties
• Interpersonal violence

“The AHC Model demonstrated that it’s possible to screen people for their core needs on a national scale,” said lead author Will Parish, Ph.D., a health economist at RTI. “Furthermore, our findings suggest that helping people connect to the right services can reduce costly hospital visits without sacrificing care quality.”

Dr. Parish and his co-authors, who included RTI’s Fang He, Ph.D., and Heather Beil, Ph.D., found that the AHC Model lowered health care costs for both Medicaid and traditional (fee-for-service) Medicare, with most of the savings—nearly 80%—coming from people covered by Medicaid only. It also found fewer inpatient hospital stays and fewer emergency department visits, suggesting less reliance on hospital-based care.

Additionally, the evaluation found the model worked best when people were also enrolled in other Medicare payment models, suggesting the programs strengthened each other through better care coordination, care management and navigation support.

“The fact that the AHC Model appears to have worked better for beneficiaries in other Medicare payment models highlights that screening and navigation can complement ongoing efforts by CMS to reduce cost and improve quality,” said Dr. He. 

The research team noted that the model’s success was supported by trusted relationships between beneficiaries and “navigators,” trained staff who work one-on-one with beneficiaries to guide them through the complexities of the health care system. Navigators frequently helped individuals keep medical appointments, understand available services and connect with community-based organizations.

The final report concludes that universal screening and targeted navigation may be an efficient approach when resources are limited. Findings showed that addressing even part of a beneficiary’s unmet needs, such as transportation for health care visits, can shape patterns of care and reduce reliance on hospital services.

Read the full evaluation

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