Medicaid could play key role in addressing social factors in healthcare
Social determinants of health (SDOH) such as food insecurity and housing instability can determine health outcomes, but the healthcare industry isn't effectively collecting SDOH data or addressing social needs that can affect a person’s health, according to a new report by the National Quality Forum.
The NQF worked with CMS and other stakeholders to develop a framework for how Medicaid can address social determinants.
They created a plan that makes state Medicaid programs hubs that support the healthcare system in addressing SDOH. The report’s recommendations would allow state Medicaid programs to “better assess and address social needs in healthcare,” NQF said.
Providers increasingly see the connection between social factors and health. For example, a lack of transportation can affect patients getting to appointments and lack of food or housing can impact patients living with chronic conditions.
In a recent interview with Healthcare Dive, Dr. Amy Flaster, an assistant medical director for the Center for Population Health at Partners HealthCare in Boston, a physician at Brigham & Women’s Hospital and vice president for health management and care management at Health Catalyst, said population health management efforts work best when SDOH are taken into account.
Payers are increasingly incentivizing providers to address these social issues. Pay-for-performance and alternative payment models can integrate SDOH into reimbursement plans. Massachusetts was the first state in the nation in October 2016 to create a Medicaid payment model that added SDOH variables to medical diagnoses, age and sex.
The NQF said many Medicaid programs address SDOH and collect data to bring together health and non-health services to address the social problems, but it’s not often in an organized way. Medicaid programs can help overcome SDOH barriers “by strengthening linkages between the community and healthcare systems, facilitating the exchange of information, and leveraging payment methods and incentivizing the discovery of new ways to deliver care and the adoption of best practices,” according to the report.
The panel offered six suggestions to support implementing the framework:
- Acknowledge that Medicaid has a role in addressing SDOH.
- Create a comprehensive, accessible, routinely updated list of community resources.
- Harmonize tools that assess SDOH.
- Create standards for inputting and extracting social needs data from EHRs.
- Increase information sharing between government agencies.
- Expand the use of waivers and demonstration projects to learn what works best for screening and addressing SDOH.
More focus on social determinants from a payer as prominent as CMS could push more providers to invest in compatible EHR tools and pursue relationships with community groups.
“State Medicaid programs should leverage their role as a major payer for health services to coordinate partnerships between health systems and community service providers, incentivize data collection and link Medicaid enrollee data to other data sources that can be used to assess social needs like food insecurity and housing instability. Ultimately, these efforts will lead to a more holistic approach to improve the health populations with the greatest need,” according to the NQF.
Medicaid taking on a more active role would also likely spread to private payers. Aetna is already working in the area of social factors in healthcare. The insurer invests in population health projects that look to reduce chronic diseases, provide walkable neighborhoods and improve quality of life. An Aetna Foundation-financed study found that investments in certain areas did result in better health outcomes.
- National Quality Forum Food Insecurity and Housing Instability Final Report
- Healthcare Dive Providers go deeper with population health, weighing social factors