Among the good news trends for U.S. health care over the last year is the flourishing cross-sector and cross-agency collaboration to address the social determinants of health. While much attention has focused on new collaborations between health care and community-based organizations, groundbreaking progress is also being made by state Medicaid and public health agency leaders that are partnering under the U. S. Centers for Disease Control and Prevention’s (CDC) 6|18 Initiative.

This CDC effort brought together Medicaid and public health leaders in nine states — Colorado, Georgia, Louisiana, Massachusetts, Michigan, Minnesota, New York, Rhode Island and South Carolina — to implement practical preventive strategies for controlling asthma, reducing tobacco use, and preventing unintended pregnancies for Medicaid beneficiaries. All 6|18 interventions have an evidence base for improving health outcomes and producing short-term cost savings. With funding from the Robert Wood Johnson Foundation (RWJF), the Center for Health Care Strategies partnered with the CDC, the Centers for Medicare & Medicaid Services, the Association of State and Territorial Health Officials, and the National Association of Medicaid Directors to assist participating states as they tailored interventions for their respective health care delivery systems.

Maximizing Medicaid-Public Health Partnership Contributions

While some of the participating states had a history of Medicaid-public health collaboration, others had little or no experience working across these agencies. The 6|18 Initiative helped establish or strengthen cross-agency relationships by supporting: (1) Medicaid and public health officials’ creation of joint project action plans; (2) shared contributions to implementation activities; and (3) collective participation in regular technical assistance calls and learning events. In particular, the effort sought to capitalize on each agency’s complementary roles and skill sets:

Medicaid CapabilitiesPublic Health Capabilities
  • Authority over benefits and coverage
  • Expertise in health care payment and delivery
  • Development of health quality goals
  • Collaboration with health plans
  • Access to and analysis of state and federal clinical and health expenditure data
  • Disease-specific expertise, with access to data on disease patterns, causes, and locations
  • On-the-ground knowledge of provider and beneficiary access and utilization barriers
  • Population health focus
  • Expertise in intervention design, outreach, implementation, and evaluation
  • Experience with knowledge dissemination and provider training

The results of the first 10 months of collaborative work under the 6|18 Initiative have resulted in enhanced cross-agency partnerships and significant progress on advancing implementation goals. Most of the participants interviewed by the CDC to assess the project’s early effectiveness reported strengthened collaboration between Medicaid and public health, demonstrated by better coordinated efforts (including on non-6|18 activities) and more frequent communications.

In implementing their chosen interventions, many states began by collecting data about the coverage or utilization landscapes for Medicaid prevention benefits (including via jointly developed surveys for Medicaid managed care plans and analyses of Medicaid claims data), then worked to either:

  • Enhance these benefits through payment or policy changes (e.g., one state submitted a State Plan Amendment to remove co-pays for tobacco cessation products, another engaged with Medicaid leadership to reimburse for a pediatric asthma home visiting program); or
  • Increase the use of existing benefits (e.g., one state hosted provider trainings on long-acting reversible contraception and multiple states are educating Medicaid beneficiaries about available tobacco cessation services).

New 6|18 Opportunities for Medicaid-Public Health Partnerships

Based on initial state successes, the CDC, RWJF, and CHCS are expanding 6|18 opportunities to address: (1) additional health conditions — diabetes, hypertension, and preventing health care-associated infections — and evidence-based interventions; (2) a new cohort of state Medicaid-public health teams; and (3) an additional cohort of innovative commercial insurers. CHCS will share case studies and examples from participating states to assist other payers and partners in their implementation of 6|18 program changes.

Given the evidence that these interventions produce health care cost savings and improve health outcomes, 6|18 will undoubtedly attract state enthusiasm, no matter what happens on the federal health policy front. This implementation model — built on cross-agency collaboration and strong technical support around concrete, evidence-based interventions — will continue to be a win-win for participating stakeholders across the country.

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