Positively Impacting Social Determinants of Health: How Safety Net Health Plans Lead the Way

The Menges Group
Publication Year: 2014
Patient Need Addressed: Financial insecurity, Food insecurity, Homelessness/housing, Patient satisfaction/engagement
Intervention Type: Best practices, Education, Partnership, Staff design and care management
Type of Literature: Grey

This report seeks to follow the five key areas of social determinants as outlined by Healthy People 2020, an initiative by the Department of Health and Human Services. These areas include neighborhood and built environment, economic stability, education, food security, social and community context, as well as health and healthcare. Medicaid health plans inherently provide the health and healthcare aspect of social determinants in ensuring access to comprehensive primary care and other health services. This report describes programs in which ACAP health plans are innovatively and positively impacting the other key areas of social determinants to improve health outcomes. Despite operating within fiscal constraints-and including a need for the state to achieve net Medicaid savings through their partnership with each Medicaid health plan-the ACAP plans have demonstrated a commitment and ability to innovate in the social determinants arena.

Insights Results

Overview of article/programs

  • This report seeks to follow the 5 key areas of social determinants (neighborhood and built environment, economic stability, education, food security, social and community context) and how the Association for Community Affiliated Plans (ACAP) health plans are impacting such areas to improve health outcomes
    1) Neighborhood and built environment
  • Stable housing can mitigate the impact of stress, help health plans maintain better contact with their enrollees and assure access to needed healthcare services
  • UPMC for You services a large Medicaid population in Pennsylvania and delivers a wide array of integrated care services to beneficiaries with a high level of need. The UPMC’s “shelter plus care” program was developed through a multi-party partnership including targeted enrollees, a primary care practice committed to working with persons with psychosocial challenges, the local Housing & Urban Development (HUD) and a HUD-funded housing support agency. The program saw a number of favorable results including reduction in per-member-per month claims cost, and increase in stable housing. The program will be expanded to serve more people, but there is a limit to a number of HUD-funded “slots”
  • Community-Based Housing (Health Plan of San Mateo) – Health Plan of San Mateo (HPMS) provides healthcare benefits to the county’s underserved residents, assuming responsibility for the entire continuum of long-term services (e.g., Medicaid covered nursing home). This program strives to help members live in the least restrictive settings of their choice and build and sustain a system of community-based supports that help people safely remain in their home. To help residents find adequate housing, HPSM identified supplemental funding, gathered information from a range of alternative housing providers and service organizations and developed a “Community Care Settings” pilot program. The program is still in planning phase
  • Project Connect – Project Connect, through a contract with Central California Alliance for Health (CCAH) plan, is a case management service that focuses on providing outreach and assistance to medically fragile members experiencing homelessness. CCAH also participates in Project Homeless Connect, a one-day annual event serving people that address multiple aspects of homelessness. CCAH also supports the 180/180 initiative, a multi-agency effort that helps homeless individuals move into permanent housing and provide support services needed for them to stay housed
    2) Economic stability
  • Parental income levels can influence children’s health outcomes. Job security and income are also positively correlated to determining health outcomes
  • Amida Care, a New York City-based health plan focused on serving HIV-positive Medicaid beneficiaries. The plan is sponsored by many safety net providers. Amida Care’s initiative centers around the philosophy that employment can play a major role in strengthening the physical and behavioral health status of its enrollees. As such, they hire, train and employ enrollees in a variety of community-support roles (e.g., peer specialists, community health outreach workers, health navigators, and member advisory council participants)
    3) Education
  • Education provides opportunities to improve one’s health status, break the poverty cycle and reside in safer areas. Higher education leads to jobs with a stronger likelihood of having health benefits and higher income, which in turn leads to a healthier lifestyle
  • The Community Health Choice health plan provides career counseling and workforce training to underprivileged high school students and young adults. The organization hires interns from local schools and educates them about healthcare and provides them with word experience. The organization also partners with 2 organizations to address workforce training and place underprivileged young adults in meaningful internship programs
  • Family Health Network (FHN) began a book club for completing academic work and improving children’s (ages 5-16) reading skills. A member can enroll by submitting 3 book reports accompanied by a registration form. In return they receive a club book bag, a new book, reading certificate and gift care. For every quarter they continue to participate and submit 3 book reports, they receive the rewards. As of 2013, about 1700 children have participated at a level that earned rewards
  • AlohaCare serves Hawaii’s Medicaid population. Their Believes in Me Scholarship partners with the University of Hawaii Foundation and has helped more than 300 students reach their higher education goals. The scholarship amount depends on the individual monetary needs
  • Health Services for Children with Special Needs (HSCSN) is a health plan located in DC dedicated to serving Medicaid-eligible children with special needs and disabilities. HSCSN developed a unique care coordination model that addresses many of the social determinants facing their plan members and their caregivers. Each enrollee has a care manager that ensures members access needed services. Many of the case managers attend their patient’s annual Early Intervention and Individualized Family Service Plan for evaluation of developmental delays. This attendance helps the case manager become incorporated into the care plan and better understand the member’s educational needs
    4) Food security
  • Access to healthy food is imperative in maintaining health and preventing chronic conditions. People with low incomes disproportionately live in food deserts, an urban neighborhood or rural town without access to fresh, healthy and affordable food. Food insecurity has significant health outcomes implications
  • Health Plan of San Joaquin seeks to alleviate food insecurity challenges through sponsorships, grants and partnerships with local community organizations. The initiative’s goals are to work with community organizations and families to no just deliver food to low-income individuals, but to ensure that the food is of high nutritional value and comes with educational support to help people learn how to choose affordable healthy foods and cook more nutritious meals. The program has had positive results like members buying and eating more fruits and vegetables, and using at least one of the recipes received through the program
  • CareSource launched a case management strategy that deploys Patient Navigators to more than 8000 high-risk members. Many of the members lacked healthy food options and did not understand how diet could influence their diabetic condition. The Patient Navigators partnered with The Foodbank, a community organization, to create a portable, diabetic-friendly food pack. There are also quarterly visits with high-risk members with diabetes to expand the member’s understanding of diabetes basics, discuss diabetes self-management, support health goals and connect members to relevant social services. Thus far, the program has shown that more than 80 participants are highly satisfied with the program
  • CareOregon serves Oregon’s Medicaid population and has created the Food Rx Program, which targets persons who are food insecure and/or who have chronic health issues related to diet. Enrollees get a $15 “prescription” that has 2 refills that can be spent on organic food at an area grocer. One of the program’s goals is to enlist physicians to directly educate patients on how to shop for and prepare nutritious food, and to determine whether the impact of a trolley vendor serving a food desert has an impact on purchasing and eating habits. The program will evaluated soon
    5) Social and community context
  • Health outcomes can be directly impacted by the level of social support an individual is receiving
  • Neighborhood Health Plan (NHP) is a Massachusetts managed care organization that serves Medicaid subgroups. After a close analysis of its HEDIS scores to identify adverse racial and ethnic health disparities, NHP’s recent efforts targets mammography screening, diabetes, and blood pressure. The mammography screening initiative included sending a birthday care reminder and a separate mammogram reminder postcard. Later, it included advertisements and culturally-sensitive educational messaged in newspapers. All of these strategies has a positive impact, increasing mammogram screening for African American women. For diabetes and blood pressure management, NHP’s intervention included educational and reminder mailings, a diabetes self-management toolkit, and distribution of food choice and blood pressure control booklets. They also implemented an integrated health and wellness education campaign and a reminder campaign that models the mammogram initiative. The initiative was able to begin to close the disparity in blood pressure control between whites and African Americans. NHP’s current initiative focuses on depression management
  • HSCSN created an outlet and support group tailored to male caregivers so they could discuss the needs of their children with others in similar situations. Meetings are held at the plan’s community outreach. HSCSN provides transportation for those who need it. Meetings consist of “check-ins” where each person shares any pressing issues (with their children or himself) that would be useful for the group to discuss and a guest speaker who leads a facilitated discussion. A survey of support group attendees indicates extremely high satisfaction
  • Passport Health Plan covers Medicaid populations in Kentucky created the Passport Teens program that focuses on educational efforts on teenagers in an effort to decrease the incidence of risk behaviors and preventable disease in adulthood. Initiatives under the program include sponsoring an and it-bullying radio campaign, mentoring students and more. Passport staff feel that these investments contribute to Passport’s quality score achievements
  • LA Care Health Plan, providing health coverage through California’s Medicaid program, created the Family Resource Centers in select underserved areas in LA County in an effort to extend its services to the low-income residents of its community. The first Centers were established in a predominantly Latino/Hispanic neighborhood and a predominantly African American neighborhood. The Centers help enrollees better understand their health benefits and identify local providers available to them. They also provide free classes on topics like parenting and asthma, and offer may workshops, lectures, screenings and self-management health programs. Satisfaction surveys determined that most visitors are highly satisfied with the services that they receive
  • CareSource invests heavily in employee training and education. CareSource created a “CareSource University” to support staff development. They also added an experiential poverty simulation module to its employee training process. Employees report the Simulation has helped them relate to and engage more effectively with the health plan’s enrollees

    Key takeaways/implications

    • Policy implications for the exemplified efforts include: 1) Encouragement of innovation and learning of cost-effectiveness of such investments, for which people and in which situations, at the state and federal level; and 2) Construction of state rate-setting policies that encourage experimentation and innovation in the social determinants area