Implementing social determinants of health: interventions in Medicaid managed care : how to leverage existing authorities and shift to value-based purchasing
- Collection:
- Health Policy and Services Research
- Author(s):
- McGinnis, Tricia, author Crumley, Diana, author Chang, Debbie I., author
- Contributor(s):
- AcademyHealth, issuing body. Nemours Children's Health System issuing body. Robert Wood Johnson Foundation, issuing body.
- Publication:
- [Washington, D.C.] : AcademyHealth, February 2018
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Community Health Services Insurance, Health, Reimbursement Managed Care Programs Medicaid Social Determinants of Health Value-Based Purchasing Asthma -- prevention & control Capitation Fee Cost Savings Reimbursement Mechanisms State Government Humans Oregon United States
- Genre(s):
- Technical Report
- Abstract:
- Recognizing that health outcomes are driven by factors other than clinical care, Medicaid and other payers are exploring ways to provide health-related, non-clinical services that can address social determinants of health (SDOH) and cost-effectively improve health outcomes and lower costs. Medicaid agencies are increasingly interested in how to weave SDOH interventions into broader care management strategies and in ways that align with the principles of value-based purchasing (VBP). For states operating the Medicaid program in full or in part under managed care, the Medicaid Managed Care regulations issued in 2016 by the Centers for Medicare and Medicaid Services (CMS) appear to offer targeted options to directly finance such interventions via managed care capitation payments. In 2017, Nemours Children's Health System contracted with the Center for Health Care Strategies (CHCS) to work with the PacificSource Columbia Gorge Coordinated Care Organization (CCO), a regional Medicaid payer operating as the sole managed care organization in a rural area in Oregon, to identify sustainable financing mechanisms for the Bridges to Health Pathways Hub, which provides community service referrals and care coordination to residents in the Columbia Gorge area. This issue brief draws upon the practical lessons learned through that work and provides advice for state Medicaid agencies and managed care organizations (MCOs) interested in implementing similar SDOH strategies within managed care, by reflecting upon: (1) What existing Medicaid Managed Care authorities can be used to cover community care coordination and service delivery activities related to social determinants? (2) What incentives do MCOs have to invest in such programs? (3) What are innovative ways to pay for these services, in alignment with the broader shifts to VBP?
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)
- Extent:
- 1 online resource (1 PDF file (12 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 101730845 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101730845