Understanding the AHC HRSN screening tool

What is the AHC Health-Related Social Needs (HRSN) Screening Tool?

The Accountable Health Communities (AHC) Health-Related Social Needs (HRSN) Screening Tool is a resource created to use in the AHC Model. The tool was created by the Centers for Medicare & Medicaid Services (CMS) and the Center for Medicare and Medicaid Innovation (CMI).

The goal of the AHC HRSN Screening Tool is to offer insight into whether finding and dealing with certain health-related social needs of Medicare and Medicaid beneficiaries has an effect on their healthcare costs. It also aims to improve health outcomes.

Its items can also serve as a guide for healthcare providers looking to understand health-related social needs and how they might impact patient health and well-being.

Why does the AHC HRSN Screening Tool matter?

Evidence consistently shows that addressing health-related social needs (HRSNs) such as homelessness, hunger, and exposure to violence helps healthcare professionals undo their harm to patient health.

Just like many clinical assessment tools, the HRSN Screening Tool provides results that providers may use to inform patients’ treatment plans. Additionally, when necessary, insights from the screener can help providers make referrals to community services.

Who is the AHC HRSN Screening Tool for?

Health workers and clinicians of all kinds can use this short screening tool as part of their clinical workflows. It can also be used with patients of all ages, backgrounds, and settings. While it may not be standard clinical practice yet, the use of the AHC HRSN Screening Tool will eventually become standard for all communities within the AHC Model.

CMS reports that this screener is appropriate to use in a variety of clinical settings, including behavioral health clinics, inpatient units, emergency departments, and more.

What is included in the AHC HRSN Screening Tool?

The basic version of the AHC HRSN screener has 10 items and focuses on five core domains of HRSNs that community services may help with, including:

• Housing instability (2 questions)
• Food insecurity (2 questions)
• Transportation problems (1 question)
• Utility help needs (1 question)
• Interpersonal safety (4 questions)

However, in the more recent final version of the questionnaire released by CMS, an additional 16 items based on eight new supplemental domains are also included. These domains are meant to provide a more robust picture of HRSNs and their impact:

1. Financial strain
2. Employment
3. Family and community support
4. Education
5. Physical activity
6. Substance use
7. Mental health
8. Disabilities

 

How to Use the AHC HRSN Screening Tool

The recommended frequency for the AHC HRSN Screening Tool is at least once every 12 months, but patients can be screened more frequently if needed. There are three different versions of the Screening Tool providers may use, depending on patient needs:

1. Standard – This version is intended for self-administration and is typically what providers use when screening patients.
2. Proxy – This version is nearly identical to the standard option, but its questions are adapted to allow parents, guardians, or caregivers to answer on behalf of the patient. It also features gender-inclusive language and is appropriate for use with children and patients with disabilities that prevent them from answering on their own.
3. Multiuse – Finally, this version includes language from the proxy edition, but it’s intended for patients who will be answering for themselves. It also incorporates gender-inclusive language.

Clinicians can use the original 10-item version of the screener, or they can include some or all of the additional 16 questions based on supplemental domains.

View all AHC HRSN Screening Tool Questions (PDF) from CMS for a full picture of the potential items on the questionnaire.

Before administering the tool, it’s important to explain the purpose of screening to patients. CMS has provided a sample introduction statement to include in the AHC HRSN Screening Tool, which practices can personalize as needed:

“This screening tool is being offered to help connect you to services in your community that may improve your health. Many of these services are low-cost or free of charge. By answering these questions, we may be able to provide you with connections to services or programs that may help you. Your information will be kept confidential except where law requires mandatory reporting. The information that you provide will not affect your insurance. You should answer the questions in your own way. There are no right or wrong answers.”

Scoring

While there is no specific scoring matrix for the AHC HRSN Screening Tool, certain item choices are typically underlined. If a patient chooses one or more underlined responses, they may have an unmet health-related social need. Providers should take steps to address those needs as they are identified.

Organizations can also choose which core and supplemental domains they want to include in the screening process based on their patient populations and existing care processes.

One important feature to note when scoring, though, applies to questions seven through 10. These items are focused on safety, and each of their answer choices is assigned a numerical value.

The sum of those values gives a subscore that providers can use to determine whether a person is safe at home. A score of 11 or higher for answers to these questions might indicate that a patient needs help. Likewise, in some cases, the screener’s scoring thresholds might be used to determine whether patients qualify for additional treatment services or programs.

Overall, HRSN screening enables healthcare professionals to tailor their treatment approaches for each patient and their needs. CMS notes that the universal screening of patients can also inform large efforts to make resources and community services available to as many people as possible.

Final Thoughts

The AHC HRSN Screening Tool is a relatively new resource, but it’s one that promises to help change the entire landscape of healthcare. It’s part of the broader effort to understand, identify, and respond to HRSNs during the care process. As such, it’s worth implementing into your screening and assessment routine, no matter what kind of services you provide.

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