Accountable Health Communities

Route 66 Consortium

Accountable Health Communities is a partnership between CMS and MyHealth Access Network to study if identifying and addressing health-related social needs impacts health care cost and reduces health care utilization.  Accountable Health Communities is looking at how factors outside the clinical setting impact the health of patients. 

Accountable Health Communities aims to: 

  • Conduct systematic health-related social needs screenings of patients in partner clinics 
  • Refer patients to community services that may be able to address the identified social needs 
  • Navigate Medicare and Medicaid beneficiaries to community service providers in their communities
  • Align community partners to optimize capacity to address health-related social needs. 

MyHealth is using a mobile screening process that sends a text message with a link to a screening that will identify health-related social needs and provide the patient a list of customized resources to help address the identified needs.  This process provides a valuable service to the patient with no additional workload for the healthcare facility. 

Accountable Health Communities will focus on the following core areas:  

  • Housing instability and quality 
  • Food insecurity 
  • Utility needs 
  • Interpersonal violence 
  • Transportation needs beyond medical transportation. 

The study will also provide Navigation services for high-risk Medicare and Medicaid patients through the Tulsa and Oklahoma City County Health Departments.  The patient will be contacted by a Navigator who will help connect them with community service providers in their area to meet their identified social needs. They will provide follow up support for up to a year. 

Contact: or (918) 703-4766  

Click here for the latest program update.

Click for the terms and conditions or the privacy policy pertaining to the AHC text messaging and screening services.

Nondiscrimination Notice

MyHealth doesn’t exclude, deny benefits to, or otherwise discriminate against any person on the basis of race, color, national origin, disability, sex, or age in admission to, participation in, or receipt of the services and benefits under any of its programs and activities, whether carried out by MyHealth directly or through a contractor or any other entity with which MyHealth arranges to carry out its programs and activities.

Accessible Communications

To request AHC information in an accessible format you can:

  • Call us 1-918-703-4766
  • Email us at
  • Send us a fax to 1-918-236-3435
  • Send us a letter to: Attn: AHC Staff, P.O. Box 56, Tulsa, OK 74101

Your request should include your name, phone number, type of information you need (if known) and the mailing address where we should send the materials. We may contact you for additional information.