Healthcare organizations have been going further upstream and working to address social determinants of health, including investing heavily in employment programs.
Jennifer McGuigan Babcock
Although managed care has changed dramatically over the last 30 years, its essential value proposition is the same: deliver higher quality and lower costs compared with fee-for-service arrangements.
We refuse to accept a tradeoff between quality health outcomes and affordable care. Governments and taxpayers demand both. Patients deserve both. And it is a constant challenge to deliver both.
This year’s Managed Healthcare Executive State of the Industry Survey finds that nearly two-thirds (64%) of responding healthcare executives have made improving quality and lowering costs their organizations’ prime focus-but barely more than one in six (18%) think that healthcare quality and costs are improving. Nearly half (48%) believe that quality and costs are getting worse.
But managed care is up to the challenge. Our ‘secret ingredient’ is the ability to craft creative solutions to address quality and cost. Value-based payments are a big part of the equation; they align financial incentives in the direction of paying for health outcomes instead of encounters and procedures.
Social determinants initiatives contain cost, improve outcomes
However, health plans have been going even further upstream and working to address social determinants of health. In many ways, our health is the sum total of our lived experience-what we eat, where we live, and how we work all contribute. These social determinants often have a more profound influence on a person’s health than medical care itself. And unlike our genes, these social determinants of health are not set in stone. They respond to outside influences and incentives.
States and federal policy makers have recognized the value in addressing social determinants of health, especially in Medicaid and Children’s Health Insurance Program (CHIP). A recent survey of managed care contracts or requests for proposal in 40 states, in addition to 25 approved § 1115 demonstrations, found that many included requirements and incentives for managed care organizations (MCOs) related to social determinants of health in contracts or requests for proposals. At the same time, more than nine in 10 Medicaid MCOs provide services to improve social determinants of health.
Health coverage helps people find, keep jobs
Employment, for instance, is a social determinant of health. In many ways, Medicaid is a jobs program, and statistics bear this out: More than six in 10 able-bodied Medicaid recipients (nonelderly, non-dual eligible, non–Supplemental Security Income recipients) already have full-time or part-time employment. Among able-bodied adults covered under Medicaid expansion, about eight in 10 are similarly employed.
Enrollees report that coverage helps them find and keep jobs. In Michigan, 69% of working adults said coverage through Medicaid expansion made it easier to work or made them better at their jobs. In Ohio, three-quarters of non-working adults said such coverage made it easier to look for work.
How health plans are addressing employment
Safety net health plans that are members of the Association for Community Affiliated Plans (ACAP) have invested heavily in innovations to address social determinants of health, even if they fall outside the traditional bounds of Medicaid health benefits. Medicaid prohibits tax dollars from being spent on social determinants of health, so safety net health plans provide for such programs at their own expense, because they have been proven useful time and again.
In New York City, Amida Care has developed two programs to help its Medicaid members keep and find jobs. The Workforce Initiative Network is a partnership with two community organizations that provides job skills to members to pursue careers as community health outreach workers or administrative staff. The Consumer Workforce Innovator Project, supported with funds from healthcare providers and the city council, provides technical support to the hired enrollees and to contracted community providers that employ them.
In Ohio, CareSource has invested heavily in its JobConnect program. Members who opt into the program are assigned a life coach, who helps to identify a member’s strengths and assure that immediate needs-such as food, shelter, physical health, childcare-are met. Members are then connected with employment opportunities, or education opportunities to open a wider range of doors to employment. Life coaches also help the member prepare for life in the workforce-and the eventual loss of publicly supported assistance.
Ten or 15 years ago, the idea of employment assistance initiatives at health plans would have sounded strange indeed. But plans have found that filling a gap in employment assistance doesn’t just help people find good-paying jobs; these programs can enhance member engagement and keep folks engaged with their healthcare and their health plan.
Stakeholders are coming together on the issue of social determinants of health. Managed care plans are creating innovative approaches to realign incentives and advance value-based care.
As health plans step in to mend the frayed edges of the safety net, it is incumbent on plan leaders to make a clear case for plans to engage in areas that go beyond health care's traditional boundaries. State and federal Medicaid agencies are eager to improve health outcomes while containing expenses and support these efforts. It’s up to us to make the connection between health coverage, social determinants programs, and better outcomes for all.
Jennifer McGuigan Babcock is vice president for Medicaid policy and director of strategic operations at the Association for Community Affiliated Plans.