Expanding and Scaling Efforts to Identify and Address Health-Related Social Needs: Lessons from the AHC Model
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Expanding and Scaling Efforts to Identify and Address Health-Related Social Needs: Lessons from the AHC Model

Published: Jan 26, 2023
Publisher: Centers for Medicare & Medicaid Services
Health Medicare Medicaid and CHIP Federal Analytics and Operations Technical Assistance

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Authors

Laura Hanson

Mario Gruszczynski

Key Findings

  • AHC Model participant Ballad Health created three new screening, referral, and navigation programs by leveraging infrastructure from AHC.
  • Ballad Health emphasized three key strategies for scaling up HRSN screening, referral, and navigation: 1) expand or adapt HRSN screening to address new populations’ needs, 2) recruit appropriate staff who represent the patient population, and 3) leverage existing data resources to include additional populations.

Expanding and Scaling Efforts to Identify and Address Health-Related Social Needs: Lessons from the AHC Model is a spotlight on AHC Model participant Ballad Health. Leveraging experience gained through AHC, Ballad Health created three new screening, referral, and navigation programs each focused on a different patient population.

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