Medicaid and other payers increasingly recognize that health outcomes and costs are often driven by factors beyond health care — such as housing, food security, transportation, and the communities in which people live, learn, and work. As a result, payers are exploring ways to move care upstream and collaborate with community-based organizations to connect patients to health-related social services. Furthermore, Medicaid agencies are examining how to integrate such interventions into broader delivery system and payment reform strategies they are implementing.
The following executive summary and briefs share practical approaches that Medicaid stakeholders can use to overcome the challenges to investing in efforts that address social determinants. These resources were developed as part of Payment Reform for Population Health, an initiative led by AcademyHealth and Nemours Children’s Health System and made possible by the Robert Wood Johnson Foundation. The initiative worked with three states — Maryland, Oregon, and Washington — to explore how Medicaid authorities can be used to: (1) provide prevention services in community settings; (2) cover upstream prevention benefits; and (3) deliver services using nontraditional community-based providers. CHCS helped prepare the following resources to inform state efforts for adopting upstream prevention strategies. View additional briefs in the series at Medicaid Payment Strategies for Financing Upstream Prevention.
Executive Summary: Innovative Medicaid Payment Strategies for Upstream Prevention and Population Health – This executive summary highlights lessons and synthesizes takeaways for how states can use existing Medicaid authority to finance innovative upstream prevention and population health initiatives, identified as part of the Payment Reform for Population Health initiative.
Implementing Social Determinants of Health Interventions in Medicaid Managed Care: How to Leverage Existing Authorities and Shift to Value-Based Purchasing – This brief provides advice for state Medicaid agencies and managed care organizations interested in implementing social determinants of health strategies within managed care, including what existing Medicaid authorities can be used to cover community care coordination and service delivery activities related to social determinants. It also explores innovative ways to pay for these services.
Integrating Community Health Workers into State and Local Chronic Disease Prevention Efforts: Program and Financing Considerations – This brief examines the evidence behind incorporating community health workers (CHWs) into upstream prevention efforts and discusses financing options available to support CHWs. The brief highlights Washington’s reform effort, including its interest in utilizing CHWs to address prevention.
Making the Case for Prevention: Why Washington’s Accountable Communities of Health Should Pursue Domain 3D Chronic Disease Prevention Projects – This brief makes the case for why states should invest in chronic disease prevention and outlines the rationale for why Accountable Communities of Health should pursue Medicaid transformation projects related to prevention and health promotion.