Build versus Buy


Implementing CMMI's Accountable Health Communities Model

The $157 million that Health and Human Services (HHS) has promised to fund CMMI’s Accountable Health Communities has certainly set hundreds of healthcare institutions scrambling to become one of the 44 bridge organizations that will pioneer the new care model for addressing social determinants in Medicaid and Medicare beneficiaries.  

Although there is plenty of emerging evidence that points towards social determinants as a key culprit behind high healthcare costs and poor outcomes, the U.S. healthcare system has never comprehensively explored models to effectively treat social determinants. Now, however, bridge organizations are being asked to screen Medicaid beneficiaries for unmet needs, refer them to community services, help high-risk individuals navigate resources, and work with community organizations to ensure proper alignment between patient “needs” and community “services.” Regardless of whether you’re on a track to raise awareness among beneficiaries, assist them in connecting to services, or full-out working to align the proper care between the clinic and the community, technology is going to play a vital role in transforming the model of care at your organization.

The Accountable Health Communities model is quite the change from the status quo and, what’s worse, the five-year timeline laid out by CMMI is aggressive for a bridge organization to design, implement, and refine a solution from scratch. The workflow and staffing changes alone to see success in a Track 1 (Awareness) or Track 2 (Assistance) organization are daunting, but in order to actual serve as a hub for coordinating and distributing care across a network of sites will require well-developed and dedicated software. And herein lies the dilemma: 1) build an “in-house” solution from scratch by modifying an existing piece of technology like an EMR, or 2) buy an existing solution specialized in addressing social determinants (like Healthify) and work with experts in the field to customize the tool as needed.

The desire to go with option 1 is tempting, and it seems strong at first glance. If you’re the project lead on this grant, you probably feel that you’ll have institutional control by working with your organization’s IT team. Maybe you think you can save money by trying to modify the expensive health record or case management system that your company purchased. How hard can it be to get the right software in place? List some community resources, identify some patient needs, and do some screenings and – bam! – your organization is on its way to managing social determinants. Except modifying existing software like EMRs or case management systems is very expensive and you’re trying to square the circle. Building a custom IT solution is even more time-consuming and, in some cases, might be the most expensive option on the table.

With a short five-year timeframe and pressure to see results out of the Accountable Health Communities model, the best bet you can make is implementing an existing social determinants solution like Healthify. Since CMMI’s model specifically calls for refinement, you can use Healthify at relatively low-risk, making note of what works well in your model for addressing determinants. Whereas custom-built software suffers from high upfront costs and, if the software fails to work, then your organization is unable to recoup the cost and has lost valuable time in evaluating the Accountable Health Communities model. Healthify, on the other hand, can get your organization making community connections and patient referrals from the start. As time progresses, you can take advantage of our software and social work expertise to further refine our software solution into your organization’s best practice.

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Before applying to be a bridge organization for the Accountable Health Community, consider buying dedicated social determinants software before trying to build it: Your patients, staff, and CMMI alike will thank you for it.

EDIT: Deadline for Grant Submission has been extended to May 18, 2016 at 1:00 p.m. ET.

Topics: Healthify social determinants of health Medicaid

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