Medicaid populations experience high rates of health disparities linked to socioeconomic, cultural, and environmental factors that shape health beyond medical care, known as social determinants of health (SDOH). Accordingly, addressing the social needs of Medicaid enrollees is essential to not only improve the overall health and well-being of enrollees but also to reduce the costs of providing health care to these enrollees. In advocating for whole-person care, several states encourage Medicaid Managed Care Organizations (MMCOs) to address the medical and social needs of enrollees, including aligning MMCO contractual requirements and payment mechanisms with such efforts. Even in states with no contractual mandates, some MMCOs have implemented SDOH-promoting programs – possibly motivated by market forces or because of success in other states with requirements.
\nObjectives
\nMethods
\nTwenty-six interviews were completed with MMCO representatives representing nine states. Each participant served in a state-level leadership position in the execution of efforts to address the SDOH. Transcripts were analyzed by two researchers, following Braun and Clarke’s (2006) approach for thematic analysis.
\nResults
\nInvestments in SDOH were described as creating a “win-win” situation for Medicaid enrollees, the MMCOs, and community partners. MMCOs’ attention to members’ social needs resulted in appropriate healthcare utilization, improved member health outcomes, and reduced medical costs. MMCOs relied on intentional and meaningful community partnerships to not only deliver quality whole-person care but also to support community-based social infrastructure to address community social and medical needs. Through these efforts, MMCOs extend their organizational capacity and improve their competitive advantage.
\nConclusion
\nMedicaid populations have unique health care challenges that often create poor health status and result in inappropriate utilization of health care, which in turn increases costs while still leaving some needs unmet. MMCOs are finding that addressing SDOH and medical needs simultaneously alleviates many operational challenges and improves the lives of those served.
\nImplications
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