Medicare Should Support Community-Clinical Partnerships, NASEM Report States

Medicare is urged to reconsider its funding approach for partnerships between primary care physicians and community organizations aimed at boosting patient health. A recent report titled "Using Community Partnerships to Inform the Prevention Strategy of the Center for Medicare and Medicaid Innovation," published by the National Academies of Sciences, Engineering, and Medicine (NASEM), highlights this need by analyzing community-clinical partnerships and calling for new payment and policy methods.

The report arose from Medicare’s request to review existing evidence on community-clinical collaborations and determine if enhancements to payment models are necessary. Two co-authors, Dr. Alex H. Krist from Virginia Commonwealth University and Dr. Andrea A. Anderson from George Washington University, discussed the critical insights gleaned from the report.

They emphasized that effective partnerships should be tailored to meet the community's specific needs, ranging from informal connections to structured agreements that align their services with the clinical objectives. Dr. Anderson pointed out that many factors influence patient health, often taking place outside of the clinical setting. "Patients spend far more time in their communities than in the exam room," she noted.

For a partnership to be effective, Dr. Krist stated that three key prerequisites must be met: strong clinical leadership committed to community collaboration, adequate resources from community organizations, and robust navigation services, which may include community health workers and effective digital connectivity.

The report outlines that effective community-clinical partnerships share a common direction and focus on population health. Dr. Krist illustrated this with an example from Alaska’s Nuka System of Care, where care is led by the community itself, promoting a sense of ownership among the recipients of healthcare services. Partnerships can originate in various ways, whether clinicians identify gaps in services they cannot address or community organizations approach healthcare providers with proposals for collaboration.

Establishing a shared mission is essential, according to both doctors. While formal mission statements can be helpful, aligning the objectives of both clinical and community partners plays a crucial role in maximizing the benefits offered to the community. Flexibility in these partnerships is also necessary, as patients’ needs may evolve over time, reflecting the dynamic nature of their lives.

One successful model highlighted in the report is the Accountable Health Communities demonstration by the Centers for Medicare & Medicaid Innovation (CMMI). Active from 2017 to 2023, this initiative yielded over $200 million in savings and illustrated how systematic screening and resource allocations led to improved patient outcomes and reductions in hospitalizations.

The co-authors stressed the importance of consistent communication and ongoing assessment of patient needs. Dr. Anderson noted that their findings indicate the need for significant continued investment in community programs to ensure they remain sustainable and effective over the long term. Many promising initiatives falter when funding is abruptly cut, leaving patients with continued or heightened needs.

Dr. Krist underscored the legislative framework that enables CMMI to broaden successful demonstration projects that yield better health results without increased costs. The success of the Accountable Health Communities model supports the argument for more widespread implementation of similar partnerships across the country, potentially benefiting various healthcare systems and accountable care organizations.

In conclusion, both Dr. Krist and Dr. Anderson advocate for a systematic, well-funded approach to integrating community organizations with clinical practices, stressing the vital roles that these partnerships can play in enhancing patient care and achieving comprehensive health outcomes. As outlined in their report, embracing the unique strengths of both communities and healthcare providers can drive significant advancements in public health, reinforcing the necessity for Medicare's active involvement in facilitating and financing such collaborations.