Through its acceptance into the Accountable Health Communities (AHC) model, The Health Collaborative (THC) and its local community partners seek to assist the Centers for Medicare & Medicaid Innovation (CMMI) in testing whether systematically identifying and addressing the health-related social needs of Medicare and Medicaid beneficiaries’ impacts total health care costs, improves health, and enhances the overall quality of care. An integral part of THC’s proposed approach is a comprehensive and integrated technology platform that meets the requirements of Track 3 of the AHC model:
- Screening of community-dwelling beneficiaries to identify certain unmet health-related social needs;
- Real-time referral of community-dwelling beneficiaries to community-based service agencies;
- Closed-loop navigation services to ensure appropriate disposition of referrals made to high-risk beneficiaries; and
- Performance monitoring (both at the beneficiary and agency level) to inform community quality improvement efforts
THC’s Accountable Health Community application will cover roughly 400,000 Medicare and Medicaid beneficiaries, and will include one bridge organization and approximately 20-25 sites (a combination of clinical delivery, navigation, and community service providers) with an estimated 100+ named system users. THC seeks respondents to this RFP with a proven track record of developing and updating an electronic resource inventory of available community service organizations, managing a patient-centric referral process between clinical and community-based settings, and integrating with resident technology solutions in a variety of care settings (i.e., electronic health records, health information exchange, client relationship management systems, etc.).
We are no longer accepting responses for this RFP – submissions closed at 1:00 PM (EDT) on July 28, 2017. Questions should be sent to Tim Polsinelli, Senior Director, Informatics, at tpolsinelli@HealthCollab.org.