Medicaid managed care organizations (MCOs) are increasingly interested in using tech-enabled solutions to address the health-related social needs (HRSN) of their members. Examples of HRSN-focused tech solutions include web and mobile platforms for screening, coaching, meal and grocery delivery services, and transportation provision. Tech solutions are one potential tool MCOs can use to meet the wide-ranging needs of their members at broad population level scale. Addressing HRSN is a key strategy to improve health outcomes and reduce health care spending in Medicaid. Using tech solutions to address HRSN offers the potential to transform social care by bringing more accessible and cost-effective services to Medicaid beneficiaries.

To learn more about MCO opportunities for addressing HRSN through technology, the Center for Health Care Strategies interviewed 12 Medicaid MCOs in three states (Iowa, Kentucky and New York) participating in the Medicaid Innovation Collaborative, a national initiative that convenes states and health plans to support tech innovations. The 12 MCOs interviewed have either adopted tech-enabled strategies to address Medicaid members’ social needs or were considering new tech solutions. This blog post explores takeaways from our conversations including how the MCOs are leveraging technology-enabled innovations to address HRSN, the importance of state Medicaid levers to advance the adoption of these solutions, and barriers and facilitators to scale solutions.

Common Needs: Food, Housing, and Transportation

The Medicaid MCOs interviewed all identified food, housing, and transportation as the primary social needs of members requiring attention. Each of the MCOs screen at least a subset of their members for HRSN and many use community resource referral platforms to connect members to available resources. Some plans also started contracting directly with community-based organizations (CBOs) or technology vendors to directly address their members’ social needs. For the MCOs that contract with CBOs or vendors, the most common HRSN services are food and transportation. All MCOs noted the challenge of providing housing for members who are experiencing homelessness or have unmet housing needs.

Promise of Tech Solutions

Interviewees also noted that tech-enabled solutions for HRSN offer an efficient and accessible way to address unmet social needs in communities. Such solutions are especially vital in rural or communities with limited services, as MCOs can partner with these tech-enabled vendors to address service gaps and expand CBO capacity to serve additional members. These tools — including both web and mobile applications — are adaptable and can be scaled across geographies, making them invaluable for addressing HRSN on a broader scale, particularly for MCOs working across multiple markets.

To date, however, among the MCOs interviewed, the implementation of HRSN tech-enabled solutions has been largely limited to short-term pilot programs (1 to 12 weeks) or to limited subpopulations, such as members with complex health and social needs, which limits the impact of these innovations. Our interviews with MCOs illustrate some of the challenges behind this limited implementation and offer opportunities for more widespread adoption of tech-enabled solutions.

Challenges in Adopting Tech-Enabled Medicaid Solutions

While tech solutions for addressing HRSN in Medicaid are promising, the MCOs interviewed identified challenges in adopting them more widely. These challenges include: (1) a lack of data to prove efficacy in improving health outcomes and reducing costs; (2) tech companies’ unfamiliarity with Medicaid processes; and (3) financial hurdles to contracting and expanding services.

1. Insufficient Evaluation Data. Lack of robust evaluation data, especially among Medicaid populations, makes it difficult for MCOs to justify investing in tech solutions. A recent study found that 80 percent of digital health products had little or no clinical evidence, making it challenging to build a compelling business case for MCOs to employ these solutions. Further investment in rigorous evaluation, the authors of the study suggest, is necessary to validate clinical robustness.
2. Understanding Medicaid Managed Care. Many tech companies do not fully grasp the operational nuances of Medicaid, including processes related to contracting, credentialing, security, and compliance within MCOs. This information gap can slow or inhibit the adoption process.
3. Financial Hurdles. Securing funds to expand HRSN services is also a challenge, as these usually depend on the MCO’s financial priorities. Most MCOs offer HRSN services as an optional value-added benefit, often targeting members with complex health needs and multiple chronic health conditions. Expanding HRSN services beyond limited discretionary value-added benefits will require significant investments and predictable funding streams.

State-Level Opportunities for Supporting MCO Adoption of Tech-Enabled Strategies

State Medicaid programs can play a pivotal role in expanding access to tech-enabled solutions for Medicaid beneficiaries, as part of their broader strategy to address HRSN. States may consider leveraging Medicaid policy to provide sustainable funding pathways and spur MCO adoption of tech solutions in addressing HRSN.  

1. State Financing. By financing services targeting HRSN, states can play a transformative role in addressing Medicaid beneficiaries’ needs. Several states, such as North Carolina and California, have incorporated services targeting HRSN into their Medicaid-covered benefits through managed care rates. Covering HRSN services as benefits and embedding the costs in capitation rates enable MCOs to sustainably fund HRSN services, including through tech solutions where appropriate. CMS has also created more options for financing, allowing states to test new HRSN services via 1115 waiver demonstrations and providing guidance through a State Medicaid Director Letter on using in lieu of services to reduce health disparities and address unmet health-related social needs.
2. Quality Measurement. States can enforce standardized reporting for HRSN measures, holding MCOs accountable for meeting set quality goals. The recent introduction of the NCQA HEDIS Social Need Screening and Intervention measure, for instance, encourages health plans to proactively assess and address critical HRSNs, such as food security, housing stability, and transportation. States can also use financial incentives that encourage MCOs to meet quality measures, either through performance incentives or quality withholds.
3. Statewide Priorities. States can set clear statewide priorities regarding HRSN and outline how tech-enabled solutions can improve the delivery of services. States such as Rhode Island and Arizona have demonstrated the effectiveness of state-led priorities through the statewide implementations of HRSN screening and community resource referral platforms. Coordination at the state level can lead to more impactful and cohesive efforts, especially between community providers and tech solutions, to address the needs of Medicaid members.
4. Evaluation Support. States can invest in formal evaluation efforts that leverage clinical, utilization, and HRSN data to assess impact and cost. California, for instance, has invested in innovation and research to understand the impact of public-private partnerships on the health of Medicaid members. By coordinating efforts at the state level, Medicaid agencies can align resources, standardize practices, and establish incentives and policies for MCOs to ensure cohesion and impact.

By understanding these challenges and opportunities, MCO and state agency stakeholders can more effectively prioritize, resource, and measure the impact of tech-enabled solutions in addressing HRSN, ultimately improving the health and well-being of beneficiaries while efficiently managing resources.