Creating Positive Change by Addressing Social Determinants and Collaborating with Complex Populations

Each year the Association for Community Affiliated Plans (ACAP) brings together a passionate group of Medicaid Managed Care CEOs, industry experts, and healthcare technology partners for two days to discuss what’s working and how to do more of it. The June event drew 250 executives to the DC area to analyze policy changes and discuss how to promote forward progress through empirical data on programs such as employment and social inclusion to combat and overcome homelessness and poverty.

Being a part of the summit provided an opportunity to learn innovative and scalable approaches to political, commercial, and social change. By looking at how health plans can work collaboratives within their communities and alongside policy changes, summit attendees walked away with an opportunity to improve the lives of their members and beneficiaries.

How Policy in Shaping American Healthcare
Avalere’s Dan Mendelson inspired the group with robust data on market growth in government programs from 39% in 2013 to 47% in 2018. As a nation, it seems that we’re working on affordability and making our markets more competitive using narrower, more local networks, improving benefit design while limiting surprise billing and reducing pharmaceutical spend.

The balance, according to Mendelson, between affordability and coverage will lie in the quality and operations components. Alignment to pay for value and engage consumers with digital health and reducing utilization of opioids, for example, will determine the success of the affordability and access formula. As Mendelson alluded to, he is hopeful that with strategic partners in the healthcare technology space there is immense opportunity to improve data analytics, member engagement, and address social determinants of health (SDOH).

Additionally, Representative Joseph P. Kennedy, III (D-Mass), shed light on the day to day experiences that Medicaid beneficiaries should not have to experience. For example, Kennedy shared his thoughts that a woman who broke her wrist next to the Nation’s most prestigious orthopedic hospital in Boston, should not take an ambulance to a lower quality hospital and incur similar or higher medical expenditures. This story reinforced the idea that health plans, policymakers, and health providers should work together to give their communities the highest quality care and best possible outcome.

Addressing Social Determinants of Health (SDOH): Addressing Housing Needs
It is becoming more and more common for health plans to seek ways in which addressing social determinants of health (SDOH) can improve health at a lower total cost. One example is how housing issues are being addressed both nationally and at the state level. Diana Crumley, Program Officer for the Center for Health Care Strategies, presented their non-profit’s findings while supporting Medicaid agencies to identify how Medicaid Managed Care Organizations (MCOs) are using Medicaid contracts and 1115 waiver demonstrations to impact beneficiaries’ health through addressing social determinants ie housing, employment, nutrition, etc.

Some of the findings include the challenge of learning about an individual’s needs vs. pushing as many services at people, which is a poor experience and a waste of resources. Additionally, there was discussion around how providers are overburdened with addressing social determinants and closing the loop with the community-based organization (CBO) and the patient, showcasing the need for better communication and collaboration between all involved and all with the same goal of helping the community. As attendees shared, it pays to listen to the beneficiary and to create a provider infrastructure that is incentivized to help support the psychosocial component of health in addition to the physical one.

At the state level, L.A. Care’s Alison Klurfeld, Director, Safety Net Programs & Partnerships, shared their use of technology for plans and providers to assess and connect members with local public and social services. L.A. Care funded $20M for “room & board” housing costs through a grant called Housing for Health & Brilliant Corners impacting 300 of the 50,000 homeless members to date. With many plans, scaling and sustaining these successful programs remains a challenge with these investments that produce great reductions in medical expenditures, and therefore reduce their top line.

The Importance of Collaboration with Complex Populations
In addition to discussion on how housing challenges are being tackled, other organizations highlighted programs that help address other factors contributing to SDOH. For example, Chris Turner from CareSource and Doug Wirth, CEO of Amida Care shared novel programs helping to address employment challenges. Turner highlighted their Life Services group that builds financial stability for members via JobConnect, an employment program for its members to connect with a life coach, employment relations specialist and community employer.

An interesting finding for CareSource was that some members are challenged with generational poverty and fear making too much and going off the “subsidy cliff” when they lose their benefits such as child support credit and SNAP benefits. Wirth then spoke to the importance of educating members early on about the subsidy cliff. By creating a larger conversation around what they can do with their lives outside of poverty helped to reduce that fear.

The CEO Summit highlighted some of the truly inspirational work to educate and motivate members to become more self-sufficient and self-actualized. As Meg Murray, CEO of ACAP, shared, in addition to the great work the health plans and policymakers in attendance were already pursuing, she and her team have collaborated with the 67 health plan ACAP members supporting special needs populations.

By the end of the event, there was much excitement and key learnings for ways in which to tackle some of the industry’s biggest challenges. Although there is a need for practical thinking in ways to drive success, there are also many possibilities in how those goals can be achieved.

Friso van Reesema brings over 15 years of experience to his current role as VP of Business Development for Payers at CipherHealth. In addition to the health plan perspective, Friso volunteers at Stamford Hospital in Connecticut, a Planetree re-designated site, on their Patient Family Advisory Committee (PFAC) and the Compassionate Interactions Committee. Friso earned his Master of Public Health degree from Johns Hopkins School of Public Health, studied Cultural Anthropology at Leiden University in The Netherlands, as well as earning a Masters in Business Administration from an Erasmus program in Rotterdam and Madrid.

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