Addressing Social Determinants of Health in Medicaid Managed Care

Dutton M, Mann C, Guyer J, Osius E
Publication Year: 2018
Patient Need Addressed: Care Coordination/Management, Financial insecurity, Food insecurity, Homelessness/housing, Transportation
Population Focus: Medicaid beneficiaries
Type of Literature: Grey

With mounting evidence demonstrating the influence of nonclinical and social factors—such as unstable housing, food insecurity and interpersonal violence—on health outcomes and healthcare costs, social determinants of health (SDOH) have edged into the mainstream. State Medicaid agencies and other stakeholders are driving the SDOH evolution from theory to practice. Recognizing that solving the healthcare problem starts with attacking its root causes, they are increasingly developing innovative strategies to address Medicaid enrollees’ SDOH-related needs and crafting sustainable funding solutions.

Insights Results

Overview of webinar

  • In a webinar, Manatt Health reviews the role that Medicaid agencies and managed care plans are playing in testing social determinants of health (SDOH)- related interventions and integrating them into their healthcare delivery systems, creating a platform for “whole person” care that seamlessly addresses individual physical, behavioral and social needs
  • The SDOH evidence base is largely focused on targeted interventions for discrete populations, pilot programs and small randomized control trials. Medicaid programs and managed care plans are driving the next generation of efforts to address social service needs within an integrated care delivery platform
  • This can be achieved through several strategies: 1) Identifying beneficiaries with social needs (e.g., Medicaid MCOs and ACOs* must include screening questions related to a range of unmet social needs (e.g., housing) during an initial health assessment for all Medicaid enrollees. Plans have flexibility to design the questions); 2) Embedding SDOH into care management and care coordination; 3) building a “provider network” of community-based organizations (e.g., To support the delivery of a suite of SDOH-related services for its high-need Medicaid population, UnitedHealthcare has created on-the-ground partnerships with a spectrum of community providers (e.g. faith-based providers and nonprofits) as part of its “My Connections” program.); 4) supporting sustainable investments in community-based interventions (e.g., Oregon permits Care Coordination Organizations (CCOs) to cover “health related services”—non-covered services offered as supplements to covered benefits—to improve care delivery and community health/well-being); and 5) Evaluating the effectiveness of SDOH interventions on health outcomes and healthcare costs (e.g., North Carolina’s “Healthy Opportunities Pilots” will be implemented by Medicaid managed care plans, in close partnership with their communities, and offer targeted interventions to address a subset of Medicaid enrollees’ needs in: housing, food, transportation, employment and interpersonal safety)
  • 3 states were cited as “pulling it all together”: 1) Massachusetts MassHealth ACO Model; 2) Rhode Island Medicaid “Accountable Entities”; and 3) Washington Accountable Communities of Health