Addressing the Social Determinants of Health for Medicare and Medicaid Enrollees

Lee J, Majerol M, Burke J
Publication Year: 2019
Patient Need Addressed: Behavioral health, Financial insecurity, Food insecurity, Homelessness/housing, Patient satisfaction/engagement
Population Focus: Medicaid beneficiaries
Type of Literature: Grey

Greater use of the emergency room has been linked to homelessness. Diabetes-related hospital admissions have been attributed to food insecurity. And social isolation has been identified as a risk factor for stroke and heart attack. These are just a few of the ways in which social, economic, and environmental factors—the social determinants of health (SDoH)—have been adversely linked to health outcomes, as well as healthcare utilization and spending.

Insights Results

Overview of article

  • Social, economic, and environmental factors have been adversely linked to health outcomes, as well as healthcare utilization and spending. MCOs (managed care organizations) and MA (Medicare Advantage) plans account for a large and growing share of Medicaid and Medicare enrollment and spending and are critical to addressing SDOH
  • To learn what MCOs and MA plans are doing to address social needs among their enrollees, the Deloitte Center for Government Insights and the Deloitte Center for Health Solutions interviewed executives and leaders from 14 MCO and MA plans across the country and leaders from 4 states to learn how states are directly addressing SDOH, and how they are supporting the SDOH efforts of health plans operating within their states


  • Emerging business case for addressing SDOH: 1) A growing body of evidence shows SDOH interventions can be cost-effective. The current evidence is largely based on pilot programs, small randomized control trials, and population-specific interventions; 2) The current evidence on overall cost savings/return on investment (ROI) is sparse, but SDOH interventions may pay future dividends; and 3) Health plan executives also believe there are other reasons to invest in social needs that make good business sense. For example, some health plan executives told us that offering SDoH-related services can be a market differentiator, allowing them to win Medicaid Managed Care contracts in some states, attract new enrollees, and establish good will with government agencies, providers, and enrollees
  • 4 main strategies health plans are using to address the social needs of their enrollees: 1) Using multiple modalities to identify social needs; 2) Connecting members to services through one-on-one support; 3) Establishing strong partnerships through formal contracts and VBC arrangements; and 4) Monitoring and evaluating interventions
  • Successful SDOH initiatives implemented by health plans: 1) Philadelphia-based Health Partners Plan (HPP) partnered with a local nonprofit, the Metropolitan Area Neighborhood Nutrition Alliance (MANNA), to deliver “food as medicine” to chronically-ill Medicaid and Medicare members who struggle with food-related social needs; 2) Arizona-based Mercy Care provides permanent supportive housing to Medicaid-eligible individuals with serious mental illness; and 3) CareSource’s JobConnect program provides enrollees in multiple US states with no-cost services and supports for professional development and employment

Key takeaways/implications

  • Future implications: Some health plans are considering experimenting with technologies such as mobile apps and virtual care, while maintaining one-on-one support programs for high-need and high-risk members. Many are interested in adopting data platforms to share data and evaluate interventions more easily, but say they need to overcome significant technological and operational challenges before they can do so