Most Medicaid managed care programs consider social determinants of health

By | December 18, 2018

Dive Brief:

  • State Medicaid programs are using various partnerships to address social determinants of health, which can be a leading factor in health outcomes, according to a new report by the Association for Community Affiliated Plans and the Center for Health Care Strategies.

  • Though the report unveiled that social determinants are now common in many Medicaid managed care contracts, it also found there are few payment incentives involving those factors.

  • The two groups offered five short-term policy recommendations for CMS to improve SDOH programs, including approving more demonstrations and offering states more support for collaboration.

Dive Insight:

Medicaid programs have increasingly explored ways to address social issues to improve care and outcomes and reduce long-range costs. They’ve done this through population health initiatives with other agencies and groups, transforming care and implementing payment models that keep a person’s environmental factors in mind.

The report surveyed how 40 state Medicaid managed care contracts and 25 1115 demonstrations address social determinants. The report went by state to look at strategies to confront those issues. The researchers reviewed Medicaid systems, partnerships and funding models.

They found that states often require Medicaid payers to screen members for social needs and connect at-risk people with necessary community resources. However, states usually don’t “establish specific expectations” to address the needs. Plus, SDOH-influenced payment models that include financial incentives remain uncommon.

The two groups offered suggestions, such as CMS improving access to necessary health services and care coordination by making changes to demonstrations to enhance member engagement. CMS can also provide guidance for states about what’s working, approve more 1115 demonstrations to test SDOH strategies and offer support for outcomes-based payment for social interventions. The report also suggested improving CMS collaboration to raise awareness of social issues.

Association for Community Affiliated Plans​ CEO Margaret Murray pointed to safety net health plans as a way to help address social health issues.

“There’s a point where common sense takes over from billing codes — for people without stable housing who are leaving the hospital after surgery, it’s far less expensive to offer temporary housing than to wait for them to be readmitted,” she said in a statement. “This is where managed care can offer a superior solution to fee-for-service.”

Millions of Americans are at risk of an SDOH-related health problem. A recent study found that more than two-thirds of 500 random patients have at least one SDOH challenge and more than half have a moderate-to-high risk of financial insecurity, social isolation, housing insecurity, addiction, transportation access, food insecurity or health literacy.

Despite a recent emphasis on social factors, Leavitt Partners reported earlier this year that most physicians don’t think addressing SDOH is their responsibility. Instead, government programs like Medicaid should address the issues.

A National Quality Forum report from January found that Medicaid programs can play a key role in collecting data and addressing social needs. The report offered recommendations to allow state Medicaid programs to “better assess and address social needs in healthcare.”

In addition to Medicaid, private payers also see a need to work on social issues. A recent Industry Pulse survey found that more than 80% of payers are integrating SDOH factors into member programs. CMS is also making changes to Medicare Advantage next year that will allow payers to offer supplemental population health benefits.

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