PHP71 - Screening for and Addressing Social Determinants of Health in Managed Care

Abstract

To evaluate the prevalence of social determinants of health (SDOH) in Medicaid and dual-eligible Medicaid/Medicare populations. AmeriHealth Caritas, a managed care organization operating in 17 states and the District of Columbia, developed operational enhancements to address SDOH (unmet needs in education, health literacy, transportation, material security, and housing) for subsequent integration into its population health management and member engagement strategies. A set of SDOH assessment questions was standardized across 10 managed care plans and integrated into their continuum of services, including new member calls, telephonic and community-based care management assessment tools. Based on these findings, action steps were designed to connect members to community-based resources. Statistical analyses were performed using chi square and F-tests. From all members with collected SDOH data (N=20,339) since August 25, 2017, 38% (n=7,797) were identified as having ≥1 unmet social need (51% of whom had ≥2 unmet social needs) subsequently addressed by staff. As of November 1, 2017, 97% of members (n=19,715) remained eligible, 35% of whom were male. Compared to females, males reported having significantly (p<0.01) higher rates of: less-than high school equivalency (27.8% vs. 23.7%), health literacy challenges (16.5% vs. 12.9%), food insecurity (17.1% vs. 14.1%), homelessness and housing insecurity (2.6% vs. 2.0% and 3.0% vs. 2.6%, respectively). Members reporting housing insecurity and homelessness tended to be older than those who were stable (mean ages: housing insecure, 39 years; homeless, 41 years; stable, 36 years; declined-to-state, 25 years; p<0.001). Older members also reported more health literacy concerns (mean age: stable, 37 years; vulnerable, 49 years; p<0.001). Preliminary analysis indicates a higher rate of unmet social needs among males and older members. Further analysis will evaluate differences among race/ethnicity groups, and add SDOH to multivariable models to identify at-risk subpopulations who may benefit from proactive care management or additional interventions.