The Center for Health Care Strategies’ (CHCS) https://www.chcs.org with support from the Robert Wood Johnson Foundation (RWJF) http://www.rwjf.org, is developing a national, multisite demonstration called “Advancing Integrated Models” (AIM). AIM is promoting innovative, person-centered strategies to improve care for adults and children with complex health and social needs in order to improve health outcomes and also to foster health equity.
So far, few organizations have implemented one or more of the strategies needed and few have adopted all, and even fewer have effectively aligned these efforts internally or externally with community partners.
The multi-site demonstration will use best practice approaches in care delivery for children and adults with health and/or social needs. The demonstration will include complex care management, provide trauma-informed care, integrate physical and behavioral healthcare, and importantly address health related social needs.
For two years, each site will receive tailored technical assistance and access to national subject matter experts and participate in a peer learning collaborative to accelerate solutions across sites. CHCS will then identify and share lessons and tools from the sites’ experiences to help stakeholders across the nation increase the effectiveness of integrated care models.
According to Allison Hamblin. President and CEO at CHCS, “There is enormous energy across the complex care field to implement various strategies to improve health and social service delivery for people with complex needs. However, these strategies are typically in isolated programs. AIM seeks to promote greater integration of these approaches and create sustainable partnerships and financing pathways to support this work.”
Maimonides Medical Center https://www.maimonidesmed.org is one of eight organizations chosen to participate in AIM. Maimonides will use the funds to embed a risk stratified care management model throughout their facilities and community in order to unite elements of payer and program-reliant models. This model was developed by Maimonides through New York’s Medicaid Health Home and Delivery System Reform Incentive payment programs.
According to Karen Nelson, MD, Senior VP for Integrated Delivery Systems at Maimonides, “The AIM project will allow us to look at the resources we have supported in the last two decades including peers, care navigators, care managers, transitional care teams, and health coaches, to help us develop protocols so they are deployed to the right patient at the right time.”