Abstract
BackgroundGrowing understanding of the influence of social determinants of health (SDH) on healthcare costs and outcomes for low income populations is leading State Medicaid agencies to consider incorporating SDH into their program design. This paper explores states’ current approaches to SDH.MethodsA mixed-methods approach combined a web-based survey sent through the Medicaid Medical Director Network (MMDN) listserv and semi-structured interviews conducted at the MMDN Annual Meeting in November 2017.ResultsSeventeen MMDs responded to the survey and 14 participated in an interview. More than half reported current collection of SDH data and all had intentions for future collection. Most commonly reported SDH screening topics were housing instability and food insecurity. In-depth interviews underscored barriers to optimal SDH approaches.ConclusionThese results demonstrate that Medicaid leaders recognize the importance of SDH in improving health, health equity, and healthcare costs for the Medicaid population but challenges for sustainable implementation remain.
Highlights
Growing understanding of the influence of social determinants of health (SDH) on healthcare costs and outcomes for low income populations is leading State Medicaid agencies to consider incorporating SDH into their program design
State Medicaid programs are tasked with designing, implementing, and co-funding public health insurance systems for low income individuals whose costly healthcare needs are often intertwined with high social needs, such as housing instability or food insecurity
We found that housing instability and food insecurity were the most often cited areas of data collection and referral
Summary
Growing understanding of the influence of social determinants of health (SDH) on healthcare costs and outcomes for low income populations is leading State Medicaid agencies to consider incorporating SDH into their program design. State Medicaid programs are tasked with designing, implementing, and co-funding public health insurance systems for low income individuals whose costly healthcare needs are often intertwined with high social needs, such as housing instability or food insecurity These social needs, often referred to as social determinants of health (SDH), have been shown to drive higher utilization, higher cost, greater health disparities, and poorer health outcomes [1] many State Medicaid agencies and Medicaid managed care organizations are testing new approaches for SDH screening, referral, and community partnerships that address such needs directly [2]. The goal of this project was to identify the current and future SDH priorities of State Medicaid agencies and collect specific examples of delivery system innovation
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