Two New Publications on Medicaid Managed Care’s Role in Addressing Social Determinants of Health

WASHINGTON, DC (Dec. 13, 2021) –Two new publications from the Geiger Gibson Program in Community Health Policy explore the current and potential role of Medicaid managed care in addressing beneficiaries’ social determinants of health. The Geiger Gibson Program is based at the George Washington University Milken Institute School of Public Health. The reports are part of a project funded by the Robert Wood Johnson Foundation’s “Research in Transforming Health and Health Care Systems” program.

In recent years, states increasingly have sought to use Medicaid managed care to advance a strategy of health care as an entry point into access to a broader array of services aimed at addressing underlying social determinants of health. The first publication presents findings from a contract review of Medicaid managed care organization contracts from 39 states and the District of Columbia. Based on the authors’ assessment of key social determinants of health-related contractual domains, the authors find that the contracts contain only limited specifications related to identifying and addressing health-related social needs and do not address how broader health-related social needs will be financed

“The study shows states view efforts to address the social determinants as squarely within the scope of Medicaid managed care initiatives,” Sara Rosenbaum, one of the studies’ authors and the Harold and Jane Hirsh Professor of Health Law and Policy at GW, said. “The contracts demonstrate this overall commitment; at the same time, they provide only general direction and delegate broad flexibility to plans and providers to determine the range of services and identify approaches that may work best for members and the communities the plans serve.”

The second publication presents key findings from interviews with Medicaid officials, Medicaid managed care plans, community health centers, Primary Care Associations, and community-based organizations in five states -- California, Colorado, Georgia, Illinois, and Pennsylvania.  Among the mix of states with varying social determinants of health-related contractual requirements, the following main themes emerged: (1) Medicaid managed care contract language reflects an increasing, but still flexible, focus on social determinants of health that is in its early stages; (2) Because Medicaid finances “medical assistance” and not health-related social services, providers must find alternative sources of social services funding; (3) A model that integrates Medicaid funding with sources of social services financing would improve providers’ ability to meet the range of patient health care and social needs; (4) Inconsistent social determinants of health screening tools limit the cohesiveness and usefulness of information across organizations; (5) The strength of the relationship among managed care organizations, community health centers and local social service organizations emerges as a critical factor in the ability to use managed care to address social determinants of health; (6) the COVID-19 pandemic has enhanced the need for strong managed care/health care/social services relationships; (7) Flexibility in approaches to financing and delivering social determinants of health services is highly useful at this early stage of health care/social service integration in order to give plans, providers, and communities many different options for addressing the intersection of health care and health.  At the same time, a consensus emerged regarding the need for new sources of funding to be able to better address patient health and wellness along with a need for standardization of social determinants of health screening tools, interoperable data collection systems, better information regarding health-related social services spending, and a clearer approach to how value-based payment arrangements will be used to support health care and social services integration.

“As social determinants increasingly drive the care model and value-based payment arrangements, this study provides important insights and lessons for safety net payer, provider, and community partner stakeholders. As with health care delivery in general, to be more effective, we will need to move toward a more integrated model and away from the current unmonitored patchwork of health and social services,” Peter Shin, principal investigator of the research project, Associate Professor of Health Policy and Management at GW, and Research Director of the Geiger Gibson Program in Community Health Policy, said.

The first publication, “Review of Social Determinants of Health Terms in 2019-2020 State Medicaid Managed Care Contracts” can be accessed here.

The second publication, “Opportunities and Challenges for Medicaid Managed Care Organizations, Community Health Centers and Their Partners in Addressing Social Determinants of Health in Five States” can be accessed here.

-GW-

The Geiger Gibson Program in Community Health Policy, established in 2003 and named after human rights and health center pioneers Drs. H. Jack Geiger and Count Gibson, is part of the Milken Institute School of Public Health at The George Washington University.

The Milken Institute School of Public Health at the George Washington University is the only school of public health in the nation’s capital.

The Robert Wood Johnson Foundation (RWJF) is committed to improving health and health equity in the United States. In partnership with others, we are working to develop a Culture of Health rooted in equity that provides every individual with a fair and just opportunity to thrive, no matter who they are, where they live, or how much money they have.