Medicaid Plans Tackle Social Determinants of Health but Barriers Remain

Publication Year: 2019
Patient Need Addressed: Behavioral health, Care Coordination/Management, Financial insecurity, Food insecurity, Homelessness/housing, Transportation, Trauma
Population Focus: Medicaid beneficiaries
Intervention Type: Service redesign, Technology/innovation
Type of Literature: Grey


Insights Results

Overview of article

  • This brief provides an overview of state innovations to address social determinants of health (SDOH). For example, the Section 1115 authority is a long-standing mechanism to provide states with the flexibility to conduct pilots and demonstration projects tailored to optimize the delivery of care within the state. Delivery System Reform Incentive Payment (DSRIP) programs, authorized under Section 1115 authority, provide a mechanism for state Medicaid agencies to innovate care delivery and payment linked to demonstrable improvements in health outcome metrics. The funds provided under the program are based on projected savings from implementation of state innovations (e.g., the Section 1115 waivers in Kansas, Massachusetts, New Jersey, Oregon, New York, and Texas include features that facilitate coordination between the health system and the social services systems, including support services and housing)

Key takeaways/implications

  • Among the state projects, New York’s DSRIP approach is perhaps the most ambitious, as it seeks to integrate clinical providers with behavioral health, community, and social services organizations across the entire state. It consists of 4 components: 1) A toolkit of intervention projects; 2) Community needs assessments; 3) Project selection with a role for community-based organizations; and 4) Implementation with continued funding tied to a 25% reduction in avoidable hospitalization and other quality metrics
  • The collection and exchange of SDOH information, as part of the electronic data interchange (EDI) 834 enrollment form and data maintenance transactions, could provide an efficient mechanism to identify Medicaid enrollees who have social needs and could facilitate the timely activation of the care management and referral processes through the Medicaid MCO. Electronic health records might also be another approach to capture SDOH data that develop profiles containing social need information that could be used across clinical sites
  • To develop such profiles about SDOH, the National Academy of Medicine recommends that all members of the integrated care team have access to patients’ SDOH profile. However, approaches are needed to systematically capture and share these data to affect action. Implementation of ICD-10 coding provides an expanded opportunity for the systematic collection of SDOH information through the use of specific Z codes that can capture information related to an individual’s living and social environment, educational attainment, adverse childhood events (ACEs), and other psychosocial circumstances
  • The North Carolina Department of Health and Human Services is leading comprehensive health system reform that supports population health management through to managed care, which will provide Medicaid enrollees with access to programs and services that address their social needs. MCOs contracted by the state are required to adopt standardized social needs screening beginning in mid-2019 as part of their care management strategies
  • D.C. PACT members are working toward a recommended, consensus set of screening questions related to housing, mental health, food, employment, and transportation. Upon finalization of the questions, D.C. PACT will establish a protocol for collecting the information and sharing it across systems, including potentially through the District’s HIE infrastructure, which will allow for bidirectional access for health, social, and public agencies with the capacity to communicate and track referrals. The system will include all D.C.-operated and –funded programs
  • Connected Communities for Health (CC4H) is the Upper Peninsula Health Plan’s (UPHP’s) initiative that aims to address its members’ social determinants of health in collaboration with community, state, faith-based, and other non-traditional healthcare network partners to fulfill their resource needs. Members are screened by customer service representatives for needs in the areas of adult education, childcare, commodities (e.g. household goods/furniture, baby supplies, clothing), employment, finance, food, housing, legal services, transportation, and utility assistance. Utilizing a call-center approach, UPHP has a team of staff-paid interns who serve as CC4H advocates to connect members to resources in their community
  • Future research priorities: 1) Identify sustainable funding sources to address social determinants of health; and 2) Determine the valuation of social intervention strategies that provide the most value