Principles of Accountable Health

man on a jogging path near a beach at the edge of a coastal city

The Principles of Accountable Health (below) were developed with feedback from Funders Forum participants, including individuals working for exisiting Accountable Communities for Health, private philanthropies, and federal participants.  

A working definition:

Accountable health approaches (often called Accountable Communities for Health or Accountable Health Communities) offer, in varying degrees, an integrated approach to the health (prevention and public health), health care, and social needs of individuals and communities in order to improve health outcomes, reduce costs, and resolve upstream factors that affect health.  In a value-based purchasing environment, accountable care holds providers responsible for better management of clinical conditions in a patient population; accountable health holds multiple sectors (including health and health care) responsible for the health of a community.[1]

Accountable communities for health look different depending on their focus, their stage of development, and the health care, social services, and financing environment in which they are operating.  For example, some will focus on upstream approaches with a longer time horizon and/or some will focus on services and other changes that have more immediate impact.  Similarly, some may focus on meeting individual (social and health) service needs and/or policy, systems and environmental change. 

Observations on Early Efforts to Implement and Test Accountable Communities for Health:

Many states and local communities are in the process of implementing and testing elements of Accountable Communities for Health (ACHs).[2]  These efforts frequently build on previous collaborations, such as Aligning Forces for Quality (AF4Q), State Health Improvement Plans (SHIPs), Community Transformation grants or Health Information Exchange (Beacon) grants.   A common observation is that building relationships and trust at the local level takes considerable effort and time, much more than the three years often provided under grants. When forming partnerships between and among clinical health care services and community based organizations to serve high-risk populations, different organizations need time to discover and articulate their spheres of accountability and measures of success most relevant to their sector, as well as build collaborative skills and leadership support.

Local communities also require flexibility to determine the governance structure, financing and priorities that meet local needs.   Several states are linking ACHs to state Medicaid delivery and payment system changes, which may provide a pathway to sustainability. Others are seeking multiple sources of funding or “braiding” of resources.  All are in the process of piloting, experimentation, and continuous learning about what works best in their communities.

Principles for Accountable Health--Changing Organizations Evolving Over Time:

  1. A “backbone” organization which serves as convener and integrator for a defined geographic area; that organization (or another) could also serve as the fiduciary agent.
  2. A governance structure with respected community leaders builds on a history of collaboration in addressing the health of the community while engaging a diverse consumer perspective.
  3. Effective cross- sector alignment is evident among health care providers, health plans, public health, community and social services, education, business and labor.
  4. Active engagement of community leaders and stakeholders in establishing a shared vision, goals, and agenda, with full community engagement in decision making regarding the use of resources and investment in building community capacity for this shared decision making.
  5. An ACH is responsible for improving the health of the entire community, however certain conditions or target populations may be the focus of interventions for joint action.    
  6. Data systems are aligned across sectors and participants for planning, coordination of care and services across a continuum of health and social determinants, and for quality improvement and evaluation.  Essential data for decision making will be accessible to all participants.  Each sector will establish measures of accountability for contributions to resolving community needs.
  7. A business case and return on investment is defined for all sectors engaged in the ACH. Investments may be long term or short term.     
  8. Participating organizations use evidence to collaboratively identify and address issues that require policy, regulatory, and systems change.
  9. Multiple funding sources are made available for sustainability of the ACH efforts. 
  10. Accountable Communities are engaged in continuous learning as efforts to improve the health of the community and health equity evolve over time. 

[1] Multiple sectors may include housing, food, transportation, social services, education, criminal justice and finance to name other sectors outside of health care that are often a part of accountable health initiatives. 

[2] We will link to our website for the typology of ACHs currently being tested in the United States.