Advancing innovations in health care delivery for low-income Americans

Addressing Social Determinants of Health through Medicaid Alissa Beers Associate Director, Population Health, CHCS Presentation to CSG Policy Academy October 10, 2019

www.chcs.org | @CHCShealth

About the Center for Health Care Strategies A nonprofit policy center dedicated to improving the health of low-income Americans

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Today’s Presentation  Context for Social Determinants in Medicaid  Mechanisms for Addressing Social Service Needs and Social Determinants of Health in Medicaid  State Examples  Q&A

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What Impacts Health?

Health care is only one relatively small component that influences health outcomes.

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Source: S. Artiga and E. Hinton. Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity. May 2018, Kaiser Family Foundation.

Social Determinants of Health

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Source: S. Artiga and E. Hinton. Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity. May 2018, Kaiser Family Foundation.

Medicaid’s Focus on Social Determinants Addressing beneficiaries’ social service needs is a key Medicaid strategy for:

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Tackling immediate health-related needs of complex patients

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Managing care for rising risk individuals Upstream prevention for kids and healthy adults

Value-based payment and care models for complex patients are key contextual drivers Federal regulations, waivers, and messaging are supporting state innovation and experimentation 6

Overview of Medicaid SDoH Activities and Levers SDoH activities include: »Screening »Referrals and navigation »Non-health services delivery »Community and state level policy changes Levers to foster provider and plan action: »Expand benefits »Delivery system program requirements »MCO contracts »Financial incentives/value based payment »Quality measurement »Rate setting 7

Managed Care Contracts: Key Findings Most common requirements center around SDoH screening and referrals MCO contract language is flexible rather than prescriptive States vary in how broadly or narrowly SDoH is defined 15 states align their SDoH requirements with broader delivery system reform efforts 8

Payment incentives explicitly linked to SDoH are rare, but increasingly deployed

Strategies Medicaid MCOs Use to Connect Members to Social Services 93%

91%

81%

67%

66%

52% 20%

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Source: Kaiser Family Foundation. https://www.kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-heal th-and-health-equity /

Spotlight on Asthma Home Visiting Programs  States may expand access to home visits by licensed professionals or qualified lay health workers to provide intensive self-management education and reduce home asthma triggers  Under CDC’s 6|18 Initiative, Rhode Island worked to:

» Demonstrate HARP’s effectiveness at improving pediatric

asthma outcomes and reducing health care costs associated with asthma-related hospital and ED visits; and

» Make the case to Medicaid leadership to reimburse HARP providers.

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Limitations to Medicaid’s Role  Well-positioned to address individual patient needs, not necessarily broader social determinants  Unease with expanding role beyond coverage of medical services  Constrained by tight state Medicaid budgets and limited new funding  Risk of provider burnout amidst broader delivery system changes  Dependent upon new partnerships between health care and social services  Delegation of provider contract requirements to MCOs 11

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Advancing innovations in health care delivery for low-income Americans

Question & Answer

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www.chcs.org | @CHCShealth