Creating Accountable Communities for Health

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A number of provisions in Affordable Care Act (ACA) promote investments in public health and transformative changes to the health insurance system. The law also prescribes modifications to the health care delivery system that have the potential to make significant and lasting impact on how our country supports new strategies to improve population health outcomes. Two important changes are: the State Innovation Models Initiative (SIM) grant funding for the creation and testing of new health care models; and the Community Health Needs Assessment (CHNA)requirement for nonprofit hospitals, which can be leveraged for public health investment and cross-sector collaboration. 

Both the SIM grants and hospital CHNA requirements offer distinct and exciting opportunities for those in public health, health care, community-based organizations, and others to collaborate on community health. 

Hospital VisitSIM Initiative

The federal government is making up to $300 million available to states for testing innovative transformations to the health care system that will lower cost while improving care for Medicare, Medicaid and Children’s Health Insurance Program (CHIP) participants. Nationwide, six states are in the midst of implementing plans to transform their health care delivery systems that willtest and showcase new payment and service delivery models ultimately designed to reduce the total cost of care (TCOC): Arkansas, Maine, Massachusetts, Minnesota, Oregon, and Vermont. Another 19 states received grants to support designing new care models, and will be eligible to apply for additional federal funds once their planning is complete. A full list of states participating in the SIMs initiative is available here.

By realigning finances to pay for health outcomes rather than quantity of services (or fee-for-service models), the new TCOC systems are creating unprecedented incentives for hospitals and health systems to invest in community supports that improve health. Housing vouchers that allow the homeless to better manage their diabetes, and prescriptions for fresh fruits and vegetables at farmer’s markets are just two examples of community-focused programs

Community Health Needs Assessments (CHNA) 

Nonprofit hospitals have traditionally relied on charity care for uninsured patients to demonstrate community benefit and sustain their tax-exempt designation. Under the ACA, each nonprofit hospital will be required to work with public health departments and community stakeholders to complete a CHNA and craft a shared plan for investing community benefit dollars to improve the community’s health based on findings from the CHNA. A plan for improving community health is submitted to the Internal Revenue Service (IRS) along with the CHNA, and hospitals will be held accountable for progress on the identified measures in future years. This issue brief on the CHNA requirement for hospitals created by the Network for Public Health Law explains these requirements in greater depth.

SIM grants and CHNAs offer new opportunities for public health departments, community and social service programs and others to collaborate with health care systems in pursuit of healthier, more vital communities. For those seeking more information or ideas about health care delivery innovations or conducting a collaborative CHNA, resources are available.

Two resources come from last fall’s conference on Creating Accountable Communities for Health, which brought leaders from health care, public health, community services, local governments and other sectors together to explore how SIMs and CHNAs could be leveraged to benefit communities. New information, ideas and questions from the conference are synthesized in a summary and companion discussion guide, developed by the Public Health Law Center and the Institute for a Sustainable Future. These resources outline lessons learned and steps that can help spark cross-sector conversations and help health agencies and health care systems identify strategies for shared action.

Take a moment to review the resources, and let us know what your community is doing to leverage the ACA’s policy changes for creating healthy, vital communities. You can email your experiences, strategies and feedback to info@commonshealth.org andpublichealthlaw@wmitchell.edu (subject line: creating accountable communities for health). We hope to update these resources with new strategies, ideas and stories of success.

Together, we can help ensure that the ACA’s full potential for improving the public’s health can be achieved.


Julie Ralston Aoki, J.D., Staff Attorney, Public Health Law Center
Jamie Harvie, P.E., Executive Director of the Institute for a Sustainable Future