Abstract
BackgroundThe significant adverse social and economic impact of the COVID-19 pandemic has cast broader light on the importance of addressing social determinants of health (SDOH). Medicaid Managed Care Organizations (MMCOs) have increasingly taken on a leadership role in integrating medical and social services for Medicaid members. However, the experiences of MMCOs in addressing member social needs during the pandemic has not yet been examined.AimThe purpose of this study was to describe MMCOs’ experiences with addressing the social needs of Medicaid members during the COVID-19 pandemic.MethodsThe study was a qualitative study using data from 28 semi-structured interviews with representatives from 14 MMCOs, including state-specific markets of eight national and regional managed care organizations. Data were analyzed using thematic analysis.ResultsFour themes emerged: the impact of the pandemic, SDOH response efforts, an expanding definition of SDOH, and managed care beyond COVID-19. Specifically, participants discussed the impact of the pandemic on enrollees, communities, and healthcare delivery, and detailed their evolving efforts to address member nonmedical needs during the pandemic. They reported an increased demand for social services coupled with a significant retraction of community social service resources. To address these emerging social service gaps, participants described mounting a prompt and adaptable response that was facilitated by strong existing relationships with community partners.ConclusionAmong MMCOs, the COVID-19 pandemic has emphasized the importance of addressing member social needs, and the need for broader consideration of what constitutes SDOH from a healthcare delivery standpoint.
Highlights
Most US states use Medicaid Managed Care Organizations (MMCOs) to coordinate the delivery of health services for Medicaid beneficiaries
Among MMCOs, the COVID-19 pandemic has emphasized the importance of addressing member social needs, and the need for broader consideration of what constitutes Social Determinants of Health (SDOH) from a healthcare delivery standpoint
Evidence suggests that MMCOs can play an important role in addressing Social Determinants of Health (SDOH) [2]
Summary
Most US states use Medicaid Managed Care Organizations (MMCOs) to coordinate the delivery of health services for Medicaid beneficiaries. Evidence suggests that MMCOs can play an important role in addressing Social Determinants of Health (SDOH) [2]. SDOH, which are the non-medical, environmental, and social factors that impact health [3], have a strong influence on healthcare-seeking behaviors, treatment adherence and health outcomes [4–6]. As the health impacts of SDOH have become more apparent, states have begun encouraging MMCOs to address the social needs of Medicaid beneficiaries as a means to improve quality and lower health care cost. More MMCOs are attempting to concurrently address the medical and social needs of their members [9]. Medicaid Managed Care Organizations (MMCOs) have increasingly taken on a leadership role in integrating medical and social services for Medicaid members. The experiences of MMCOs in addressing member social needs during the pandemic has not yet been examined
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