Washington, D.C., November 13, 2018 – The Association for Community Affiliated Plans (ACAP) and the Center for Health Care Strategies (CHCS) today released a report that surveys the ways in which states use Medicaid managed care contracts and state § 1115 demonstrations to address social determinants of health (SDOH).
The outsized influence that social determinants such as housing, employment and education have on a person’s health status has led to a sharp focus in recent years, especially among health plans that serve low-income populations. However, since the means to address SDOH fall outside the traditional health care system, policy challenges are pervasive.
The report looks at Medicaid managed care contracts in 40 states, as well as 25 approved § 1115 demonstrations. CHCS found common themes in how states leverage systems and partnerships — and structure authority and funding — to most effectively address social determinants.
While it is now common for state contracts with Medicaid managed care organizations (MCOs) to include provisions around social determinants, many states do not clarify within the contract how MCOs can utilize flexibilities within federal law to address social determinants. And while many states set goals for social determinants in contracts, comparatively few offer payment incentives.
Many § 1115 demonstrations seek to better address social determinants through better care coordination and cross-sector partnerships among community-based organizations, providers, and MCOs. States jumpstart these delivery system reforms with incentive payments and value-based payment initiatives.
“Social determinants of health play into the strengths of Safety Net Health Plans, as they have found ways to improve their members’ health while containing costs at the same time,” said ACAP Chief Executive Officer Margaret A. Murray. “There’s a point where common sense takes over from billing codes – for people without stable housing who are leaving the hospital after surgery, it’s far less expensive to offer temporary housing than to wait for them to be readmitted. This is where managed care can offer a superior solution to fee-for-service.”
“Over the last 10 years, social determinants have moved from a novelty to an integral policy lever for states,” added Tricia McGinnis, MPP, MPH, Senior Vice President, Center for Health Care Strategies. “The report’s state-by-state comparison shows that states are taking myriad approaches to addressing social determinants. What’s really exciting is taking an inventory of these efforts from across the country — and identifying the key trends, including emerging areas of innovation.”
The report details five policy recommendations for the short term. The Centers for Medicare & Medicaid Services (CMS) can improve vulnerable populations’ access to necessary health services and care coordination by suggesting modifications to demonstrations to attempt to reduce eligibility churn and heighten member engagement. CMS can also provide additional guidance on social determinants as well to clarify how plans can use in lieu of and value-added services to improve interventions on social determinants. CMS can also approve more § 1115 demonstrations that test SDOH strategies, and provide support for outcomes-based payment for social determinants of health interventions, so dollars are being used on proven and successful initiatives and models. Finally, it is crucial to enhance agency collaboration at the federal level so that social determinants-focused collaboration becomes more common.
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ACAP represents 64 not-for-profit Safety Net Health Plans in 29 states, which collectively serve more than 22 million people enrolled in Medicaid, Medicare, the Children’s Health Insurance Program (CHIP), and other public health programs. For more information, visit www.communityplans.net.
About the Center for Health Care Strategies
The Center for Health Care Strategies (CHCS) is a nonprofit policy center committed to improving health care quality for low-income Americans. CHCS works with state and federal agencies, health plans, providers, and community-based organizations to develop innovative programs that better serve people with complex and high-cost health care needs. For more information, visit www.chcs.org.