RVA Community Cares: The Richmond Accountable Health Community

Health Quality Innovators (HQI) and its partners, including IPHI, were awarded a five-year, $4.5 million grant by the federal Centers for Medicare & Medicaid Services to test an innovative healthcare model to address upstream factors that contribute to poor health.

The funds supported the creation of an Accountable Health Community called RVA Community Cares. Recognizing there are many environmental and social factors that influence an individual or family’s health outcomes, this model aims to identify and address health-related social needs. Health care providers aim to annually screen more than 75,000 patients with Medicare or Medicaid for unmet health-related social needs and connect them to local agencies and organizations that can help. The Richmond site is one of 31 locations across the country to receive this funding from the CMS Center for Medicare and Medicaid Innovation to implement the Accountable Health Communities Model.

By navigating patients to community supports for health-related social needs, RVA Community Cares will reduce avoidable hospital readmissions and Emergency Department utilization. Partners also aim to build a sustainable model for clinical-community connections that can be spread to other parts of the region and state.

As the community’s bridge organization, HQI and its partner, the Institute for Public Health Innovation, coordinate the efforts of multiple health care delivery and community service organizations in the City of Richmond, Chesterfield, Hanover, and Henrico. Participating clinical sites include Bon Secours Health System, Capital Area Health Network, Richmond Behavioral Health Authority, Richmond City Health District, The Daily Planet, and VCU Health System, the National Counseling Group, and Bremo Pharmacy.

There will be an independent national evaluation of the Accountable Health Communities Model to determine the impact of the model on quality of care and spending, including total health care costs and inpatient and outpatient health care utilization.

For more information on the Richmond Accountable Health Community, see the HQI website, or contact Rebecca Epstein with IPHI at [email protected].