JAMA Forum: How An Expanded Vision of Managed Care Organizations Could Tackle Inequities

Butler S
Publication Year: 2019
Patient Need Addressed: Homelessness/housing, Transportation
Population Focus: Medicaid beneficiaries
Type of Literature: Grey

There is growing recognition in the healthcare sector, especially among managed care organizations (MCOs), that good health—and achieving lower medical costs—requires a focus on the nonmedical factors known as social determinants that affect health and well-being.

Insights Results

Overview of article

  • Medicaid managed care plans, (e.g., AmeriHealth and CareSource), are addressing these social determinants to reduce health costs and improve outcomes for many of their Medicaid enrollees
  • Recent administrations have used 1115 waivers to permit states to allow Medicaid plans to incorporate nonmedical services into Medicaid. A 2018 waiver for North Carolina, for instance, lets the state use a certain amount of Medicaid funds to enable managed care organizations (MCOs) to pay for housing, food support, and transportation and provide services to combat violence and other forms of stress
  • Over time, these developments in policy could transform MCOs serving lower-income households and the vulnerable elderly. MCOs could in effect become “well-being” anchor organizations, encouraging traditional medical centers and nonmedical organizations to work together to address a wide range of issues that are critical to both good health and socioeconomic improvement. And because health disparities in US healthcare and outcomes are so often attributable to such factors as unstable housing and inadequate transportation—and these problems are concentrated in certain communities—changing the role of MCOs could significantly reduce health inequities
  • There are several challenges to MCOs and other organizations adopting this role: 1) Data sharing between sectors; 2) Data gaps surrounding the impact od nonclinical services (e.g., conflicting evidence on the health impact of some interventions, such as permanent supportive housing); 3) Organizational culture between medical staff and social services partners; and 4) Limited government payment reforms

Key takeaways/implications

  • An important step in improving the US health system is to reimagine the role and scope of institutions within the system as well as the healthcare business model. However, understanding of SDOH is growing and the government is creating incentives for MCOs to incorporate nonclinical services in their mix of covered benefits. Consequently, the US may be able to create a versatile new type of organization to help improve the well-being of more vulnerable households