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AcademyHealth

 

January 2022 Addressing the Social Needs of Medicaid
Enrollees: Lessons and Promising Practices
from Managed Care
The Question:

Key Findings What are challenges and lessons learned from Medicaid managed care organizations

Member engagement is pivotal to
SDOH programming and using a
high-touch approach can increase
member engagement.

Actively listening to community
partners can inform a community-
embedded approach to SDOH
programming.

Effective SDOH programming
requires flexibility, agility, and a
continuous improvement mindset.

Innovative payment and delivery
models for aligning medical and
social services are needed for
an effective transition to whole-
person care.

Robert Wood Johnson
Foundation

working to address social determinants of health (GSDOH) among their members?

Addressing inequities in health care access and outcomes among vulnerable and underserved populations is
becoming a top priority for states. To improve health outcomes and lower costs in their respective Medicaid
programs, many states are leveraging the care coordination and preventative care capabilities of managed
care organizations (MCOs) to address the nonmedical needs of Medicaid enrollees.

With support from the Robert Wood Johnson Foundation, researchers at Georgia Southern University sought
to identify Medicaid MCOs lessons learned and emerging practices from efforts to address SDOH among
their members. In interviews with eight regional and national MCOs serving eight states, the researchers asked
participants to reflect on their organizations' efforts to address the social needs of Medicaid enrollees and share
their successes and challenges. Full findings are available in Population Health Management.

The Implications:

Medicaid MCOs are undertaking a wide range of activities to address SDOH among

their members, with shared lessons learned and promising practices falling into four
themes: member-centeredness, community-centeredness, structured yet adaptable
SDOH programming, and realigning systems for whole-person care.

MCOs reported that increased contact and interaction with members was integral to building member trust
and contributing to the success of SDOH-related programming. In-home visits by social workers and the
use of community health workers were among the strategies used by MCOs to increase touch points with
members and meet them where they are.

Developing and maintaining community partnerships is also critical to Medicaid MCOs efforts to address
the social needs of their members. Developing these connections requires in-depth knowledge of community
needs and the resources available locally. MCOs reported that they purposefully hired from within the
community they served, connected with members directly within their communities, and forged relationships
with local community-based organizations and social services agencies. Partnerships with these organizations
allowed MCOs to provide tailored and responsive population-based programming that could extend the
capacity of the health care delivery system.

An intentional, structured, and coordinated approach to addressing members' social needs was frequently
reported as a best practice for MCOs. Participants noted that a dedicated SDOH department, with selectively
hired staff who were passionate advocates for enrollees' care, was helpful. MCOs also reported that having
adaptable playbooks that could provide evidence-based guidelines for developing SDOH-related programing,
based on lessons learned from pilot projects or from individual states, led to more success. Having this data
contributed to a continuous improvement mindset that was vital for advancing their efforts.

Delivering high quality, whole-person care to address member needs requires a systemic integration of social
and medical services. MCOs stressed the need for state-level policy reform that includes infrastructure support
to integrate social services into the health care ecosystem. This would allow for data exchange and payment
mechanism support across different sectors, making the work less time consuming and more sustainable.

Contact Us:

For more information on this study, please contact Bettye Apenteng, Ph.D. (bapenteng@georgiasouthern.
edu), Samuel Opoku, MBChB, Ph.D. (sopoku@georgiasouthern.edu), and Charles Owens, M.S.A.
(cowens@georgiasouthern.edu).

Research in Transforming Health and Health Care
Systems is a program supported by the Robert
Wood Johnson Foundation and administered by
AcademyHealth. The views expressed here do not
necessarily reflect the views of the Foundation or

AcademyHealth. If you would like to learn more about related work, please contact: Lauren Gerlach, M.P-P, Director,

AcademyHealth | Jauren.gerlach@academyhealth.org