Clinical Interventions Addressing Nonmedical Health Determinants in Medicaid Managed Care

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Toplines

    Addressing social determinants of health will improve patient outcomes and lower costs in Medicaid

Background

Mounting evidence shows that factors ranging from poverty and food insecurity to inadequate schools and unsafe neighborhoods contribute to disease and threaten health. Hoping to improve patient outcomes and lower health care costs, many provider organizations now offer programs to address these social determinants of health. Commonwealth Fund–sponsored researchers studied how these interventions are designed and operated in an effort to encourage dissemination of best practices.

What the Study Found

The authors conducted a search for programs focused on improving at least one social determinant of health, such as housing or transportation, for Medicaid patients. Interventions were funded by Medicaid managed care organizations, and the programs were all integrated into the clinical care delivery system. The authors identified 25 interventions, finding that:

  • most programs target patients with chronic conditions who use a lot of health care services
  • the majority are case management interventions that connect patients with community resources, such as vocational assistance and housing subsidies
  • eleven programs reported results—mostly positive—including decreased hospitalizations, cost savings, improved patient satisfaction, and increases in quality.

Flexible financing arrangements, the authors say, may make it more feasible for Medicaid managed care organizations to transition their existing case management programs to focus on social as well as medical issues. Complex Medicaid rules can make it difficult for organizations to know when and if nonmedical programs are covered under capitated arrangements. One funding option is the Health Homes program, established by the Affordable Care Act, which requires providers to combine medical case management with referrals to community and social support services.

Conclusions

A blended medical and social case management approach may be an effective way for Medicaid managed care organizations to help patients overcome social barriers to good health.

Publication Details

Publication Date:
June 15, 2016
Authors:
Laura M. Gottlieb, Kim Garcia, Holly Wing, Rishi Manchanda
Contact:
Mary Mahon, Vice President, Public Information, The Commonwealth Fund
E-mail: mm@cmwf.org
Summary Writer:
Maggie Van Dyke
Citation:
L. M. Gottlieb, K. Garcia, H. Wing et al., “Clinical Interventions Addressing Nonmedical Health Determinants in Medicaid Managed Care,” American Journal of Managed Care, May 2016 22(5):370–76.
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