PROVIDENCE – Care New England on Thursday said it has received one of 32 national Accountable Health Communities model grants from the federal Centers for Medicare & Medicaid Services, receiving an anticipated $3.9 million for a five-year initiative focused on ensuring that high-risk Medicare & Medicaid patients have access to high-quality health care services while achieving cost savings at the same time.
The Integra Community Care Network, an accountable care organization comprised of CNE, Rhode Island Primary Care Physicians Corp. and South County Health, will serve as the bridge organization for the Integra Accountable Health Communities Partnership in collaboration with a statewide network of clinical providers, community service organizations, academic institutions and governmental partners.
Clinical sites will include Memorial Hospital, Women & Infants Hospital, Butler Hospital, South County Health, The Providence Center, CODAC Behavioral Health and CCAP Health Center.
Qualifying patients will be screened for specific health-related social needs at each clinical site through the cooperative agreement.
Housing, food insecurity, transportation, interpersonal violence and utility needs are some of the areas for which participants will be screened, as well as substance use/addiction and independent living/caregiver support.
The initiative also seeks to increase Rhode Island Medicare and Medicaid beneficiaries’ awareness of community resources available.
Patients who are deemed “high-risk” will receive community service navigation assistance, to be conducted by specially trained navigators.
“By addressing critical drivers of poor health and high health care costs, the model aims to reduce avoidable health care utilization, impact the cost of health care, and improve health and quality of care for Medicare and Medicaid beneficiaries,” Dr. James Fanale, executive vice president and chief clinical officer for Care New England and chief clinical officer for Integra, said in a statement. “The key to the success of this initiative is that everyone remains focused on ensuring that the necessary services and supports are available and responsive to the beneficiaries’ needs.”