New Report Looks at Medicaid and Social Determinants of Health

A new report outlines how state Medicaid programs can improve the health of Medicaid beneficiaries through a more concerted approach to addressing social determinants of health.

The report, from the Institute for Medicaid Innovation, focuses on how state Medicaid programs, through alternative payment models and especially through managed care organizations, have implemented new programs designed to address social determinants of health such as inadequate social supports and housing, food insecurity, lack of transportation, and others.  It also highlights federal regulations that facilitate the implementation of new ways to address social determinants of health and presents brief case studies in which states, state Medicaid programs, and Medicaid managed care organizations tackle social determinants of health.

Such approaches are especially relevant to private safety-net hospitals because they care for so many more Medicaid patients than the typical community hospital.

Learn more from the Institute for Medicaid Innovation report “Innovation and Opportunities to Address Social Determinants of Health in Medicaid Managed Care.”

Medicare Advantage to Address Social Determinants of Health

Beginning next year, the Centers for Medicare & Medicaid Services will authorize Medicare Advantage plans to pay for some health-related but non-medical benefits for their members – benefits that will help address social determinants of health that affect the health status of many Medicare beneficiaries.

As explained by Health and Human Services Secretary Alex Azar at a recent event in Salt Lake City,

These interventions can keep seniors out of the hospital, which we are increasingly realizing is not just a cost saver but actually an important way to protect their health, too.  If seniors do end up going to the hospital, making sure they can get out as soon as possible with the appropriate rehab services is crucial to good outcomes and low cost as well. If a senior can be accommodated at home rather than an inpatient rehab facility or a [skilled nursing facility], they should be.

According to Azar, HHS’s Center for Medicare and Medicaid Innovation will be looking for new ways to address social determinants of health that have an impact on Medicare beneficiaries’ health.

What if we provided more than connections and referrals?  What if we provided solutions for the whole person including addressing housing, nutrition and other social needs all together?  What if we gave organizations who work with us more flexibility so they can pay beneficiaries’ rent if they are in unstable housing or make sure that a diabetic has access to and can afford nutritious food?  If that sounds like an exciting idea, then stay tuned to what CMMI is up to.

During the gathering, Azar made similar comments about Medicaid, suggesting that in the near future, federal Medicaid funds might soon be used for non-health-related benefits as well.

Learn more about Secretary Azar’s plans for addressing social determinants of health in this Fierce Healthcare article.

Medicaid to Help Pay for Food, Heat, Rent?

Maybe.

At least that is what Department of Health and Human Services Secretary Alex Azar hinted during a recent symposium held in Salt Lake City.

During the event, Azar said that HHS’s Center for Medicare and Medicaid Innovation seeks

…solutions for the whole person, including addressing housing, nutrition, and other social needs.

Azar hinted at future CMMI action, saying that

What if we gave organizations more flexibility so they could pay a beneficiary’s rent if they were in unstable housing, or make sure that a diabetic had access to, and could afford, nutritious food? If that sounds like an exciting idea … I want you to stay tuned to what CMMI is up to.

CMMI currently operates one major program that seeks to address social determinants of health:  the Accountable Health Communities model, which screens participants based on social determinants of health metrics, identifies those it considers to be at risk, and then works to link those individuals to local and community services that can help them address their health-related needs.

Significant numbers of the patients served by private safety-net hospitals face challenges posed by social determinants of health.

Learn more about Secretary Azar’s comments and the federal government’s outlook on using Medicaid to help address social determinants of health in this article in Becker’s Hospital Review.

Medicaid Birthing Model Improves Outcomes

A federal program to improve birth outcomes among Medicaid-covered women has produced positive results:  lower rates of pre-term births, fewer low birthweight babies, fewer C-sections, lower delivery costs, and lower first-year health care spending.

The “Strong Start for Mothers and Newborns” program was a four-year initiative established by the Affordable Care Act and developed by the U.S. Department of Health and Human Services’ Center for Medicare and Medicaid Innovation to employ patient education, nutrition, exercise, preparation for childbirth, breast-feeding, and family planning rather than strictly medical interventions and was delivered through three evidence-based prenatal care models:  Birth Centers, Group Prenatal Care, and Maternity Care Homes.

The program, operated in 219 separate sites in 32 states, served participants with especially challenging socio-economic risk factors:  unemployment, lack of a high school degree or GED, food insecurity, transportation challenges, chronic health problems, and previous poor birth outcomes.  The objective of the program was to find ways to overcome these social determinants of health and produce better birth outcomes and now, a new, independent evaluation has found that it did.

Learn more about Strong Start for Mothers and Newborns and what it has produced in the official program evaluation document.

HHS Seeks Feedback on Social Determinants of Health

Following up on a requirement from the Improving Medicare Post-Acute Transformation (IMPACT) Act of 2014, the U.S. Department of Health and Human Services has issued a request for information seeking feedback from providers and insurers about what they do to improve health outcomes for Medicare beneficiaries with social risk factors.

The RFI seeks to learn more about how insurers and providers identify Medicare patients with social risk factors, address those factors, and determine how much their efforts cost and whether they were effective.

The information HHS gathers will be part of a report due to Congress by October of 2019.  It will be the second such report resulting from the IMPACT Act:  the first, submitted to Congress in 2016, focused on socioeconomic information already available in Medicare data and relied heavily on work performed by the National Academies of Science, Engineering, and Medicine under contract with HHS.

Comments are due to HHS by November 16.

Go here to see the RFI “IMPACT Act Research Study:  Provider and health plan approaches to improve care for Medicare beneficiaries with social risk factors.”

States Pursuing Medicaid Reforms

A new Commonwealth Fund report looks at some of the changes states are pursuing in how they deliver and pay for care for their Medicaid recipients.

The review groups the reforms into three categories:

  • Managed care reforms – demanding more data to support bids for Medicaid managed care contracts and favoring bidders that include strong value components in their bids and that seek to address recipients’ social needs.
  • Focusing on beneficiaries with complex health and social needs – working with Medicaid managed care plans to address both the medical problems of members with complex medical conditions and the social determinants of health that cause, contribute to, or impede the treatment of those problems.
  • Integrating behavioral and physical health – expanding prevention and treatment of substance abuse disorders by restructuring delivery and payment systems.

Learn more about what states are doing to improve their Medicaid programs in the Commonwealth Fund report “Considering Federal Medicaid Policy Changes in Light of State-Level Delivery System Reforms,” which can be found here.

Eat! You’ll Feel Better

And maybe need to spend less on health care.

That is the lesson learned from a program in Massachusetts that provided home delivery of food to dually eligible Medicare/Medicaid recipients who were struggling with their meals.

In a limited experiment, selected individuals received home delivery of food:  some received general meal deliveries while others received food tailored to their individual medical conditions.  The purpose:  address a major social determinant of health in this difficult-to-serve population.

The result, according to a report published in the journal Health Affairs, was that

Participants in the medically tailored meal program also had fewer inpatient admissions and lower medical spending. Participation in the nontailored food program was not associated with fewer inpatient admissions but was associated with lower medical spending. These findings suggest the potential for meal delivery programs to reduce the use of costly health care and decrease spending for vulnerable patients.

This type of approach might be especially beneficial for private safety-net hospitals because they care for so many patients who participate in both Medicare and Medicaid.

Learn more about the program and its results in the Health Affairs article “Meal Delivery Programs Reduce the Use of Costly Health Care in Dually Eligible Medicare and Medicaid Beneficiaries,” which can be found here.

Tackling Social Determinants of Health

The growing awareness of the impact of social determinants of health comes at a time when health care providers are assuming unprecedented degrees of risk for the health of their patients, leaving many providers wondering how best to invest resources that will meet both their own needs as well as the needs of their high-cost, high-need patients.

A new document from the Commonwealth Fund, “Investing in social services as a core strategy for healthcare organizations:  Developing the business case,” seeks to serve as a manual for providers seeking to move into this relatively new territory.

The report takes providers through key steps in the process, including establishing a common definition of social service investment; identifying common barriers to social service investments; and building the business case for such investments.  It also addresses six aspects of building that business case:

  • identifying potential social investment options
  • defining success
  • measuring costs
  • determining an investment model
  • developing a return on investment approach
  • sensitivity analysis and investment launch

Finally, it identifies the major social determinants of health providers might seek to address:

  • economic stability
  • neighborhood and physical environment
  • education
  • food
  • community and social context

For a closer look at the considerations that go into the development of a cohesive attempt to address social determinants of health and several case studies, go here to see the Commonwealth Fund’s new manual “Investing in social services as a core strategy for healthcare organizations:  Developing the business case.”

Addressing Socio-Economic Challenges Through Medicaid Payment Policies

Amid the growing awareness of the impact of social factors on health, policy-makers are increasingly interested in finding ways to address those factors through state Medicaid programs.

In a new blog post, the journal Health Affairs offers six ways for states to address social determinants of health through Medicaid managed care programs.

  1. classify certain social services as covered benefits under the state’s Medicaid plan
  2. explore additional flexibility afforded states through section 1115 waivers
  3. use value-based payments to support investment in social interventions
  4. use incentives and withholds to encourage plan investment in social interventions
  5. integrate efforts to address social issues into quality improvement activities
  6. reward plans with effective investments in social interventions with higher rates

Learn more about how states can use these approaches to empower Medicaid managed care plans to address social determinants of health in the Health Affairs Blog post “Practical Strategies for Integrating the Cost of Social Interventions Into Medicaid Managed Care Rates,” which can be found here.

 

NQF to Medicaid: Do a Better Job of Addressing Social Determinants of Health

State Medicaid programs need to do a better job of measuring and addressing the social risks their patients face, the National Quality Forum has asserted in a new report.

To do so, NQF concluded, state Medicaid programs should “…work more with healthcare organizations and communities to better manage social disparities.”

How?

According to the NQF, state Medicaid programs should:

  • Acknowledge that Medicaid has a role in addressing social needs that impact health.
  • Create a comprehensive, accessible, routinely updated list of local community resources for healthcare organizations.
  • Harmonize tools that assess social needs that impact health to ensure that they collect and document the same type of information.
  • Create standards for inputting and extracting social needs data from electronic health records to strengthen information sharing between health and non-health providers and programs
  • Increase information sharing between government agencies.
  • Expand the use of waivers and demonstration projects to begin to learn what works best for screening and addressing social needs that impact health.

Learn more about how the NQF wants state Medicaid programs to address the social determinants of health in the new report Food Insecurity and Housing Instability Final Report, a link to which can be found here.