LABUN:
Welcome to Part Three of our short explainer series on Hunger Vital Sign.
By this point it may be obvious that when our intro says “short explainer series”, we mean the individual episodes are short – not the series. The series may be infinite. Or at least bounded only by the edges of the podcast era. We have a whole world of topics to explore -- start with Hunger Vital Sign and link together all the possibilities from there.
In this section, we’re expanding our horizons just a few more steps. We’ll be adding to food insecurity by examining a screening tool that combines multiple social needs – things like transportation or housing. And we’ll go past the screening stage to look at screening plus referral and navigation to services. We aren’t leaving Hunger Vital Sign behind, it’s a part of the model.
VERLANDER:
So the technical expert panel recommended two questions to identify food insecurity among community dwelling, Medicare and Medicaid beneficiaries. In the AHC model, we adapted these from the hunger vital sign, a published two question, food security screening that is shown to be sensitive, specific and valid when asked of low-income families with young children.
LABUN:
If you were paying unnecessarily close attention to Part 1 of our series, that clip will also help date the research being discussed – it drew from papers just before the 2017 publication of Hunger Vital Sign validation for adults.
The AHC Model referenced here is the Accountable Health Communities Model from the Innovation Center at the Center for Medicare and Medicaid Services.
Or the CMS CMMI AHC model with its famous AHC HRSN screen.
Those acronyms are for the benefit of people reading the transcript. Which is linked from the show notes.
And, as you heard, we have a new guest to help us understand.
VERLANDER:
My name is Katherine Verlander and I am the Deputy Division Director for a Division in the CMS Innovation Center that houses the Accountable Health Communities model, and also the integrated care for kids model.
LABUN:
Katherine is on our series for insights into a very specific question – but one that takes a lot of work to answer. We know that the Hunger Vital Sign is a tool that allows a health care practice to quickly assess whether a patient is at risk for food insecurity and the poor health outcomes associated with food insecurity. The question that our guest will help answer is: what next?
The official answer is easy:
VERLANDER:
There are a few more evaluation reports that we expect. The final report for the accountable health communities model is several years away still.
LABUN:
Officially, we don’t know. My unofficial answer is that certainty about anything is elusive, we know a whole lot more than we did a few years ago.
Work on the Accountable Health Communities model began in 2016. We’re recording this episode in the summer of 2022, and we’ve got more years to go before the model evaluation is complete . . . and before any listeners sigh over all these years, let me remind everyone that a common criticism of pilot projects is that they don’t give enough time for the programs to mature. This means they can incentivize over-simplification to fit the timeframe and can under-value preventive measures where the impacts may appear years after the original intervention. We want to get out of the cycle of searching for quick fixes that lead to bigger problems, that in turn get their own quick fixes, that lead to bigger problems, and so on.
The final report that we’re waiting on for the AHC Model has a very particular way of defining success – ones that we’ll get into in future episodes.
The questions that CMS is hoping to answer in that final report aren’t necessarily the same as questions you or I may be trying to answer. If you’re looking for well documented examples of the experiences of diverse organizations from across the country searching for the best way to work within their local health care systems to help patients address needs like access to nutritious foods, then the Accountable Health Communities model can already offer that. It can offer expert opinions on building social risk screens for health care. It can offer a structured way of thinking about all the elements of a screening, referral, and navigation system and how to track its performance. Case studies, conference proceedings, preliminary evaluation results, diagrams, charts, guides . . . So much is available and that’s all before we get to an official opinion.
You could say that the CMS Innovation Center is attempting to resolve an inner tension that underlies a lot of food and health care work; we want thoughtful policy that takes a long view on the results of upstream investments in health, and we also want something to happen right now.
Can we blend patience and instant gratification into one model? Has the Innovation Center succeeded in doing so?
You’ll get to decide. In this Part Three of our series we’re putting multi-domain social risk screens into practice, and along the way we’ll learn about how the federal government tests innovations in health care and scales proven models nationwide. You can find the transcripts for this conversation along with our previous conversations, key point summaries, and reference materials, from the link in our show notes.