Hi Dr. Terry. A key takeaway for me is the involvement of the many initiatives that address social determinants of health within and outside the healthcare system. Outside the health care system, initiatives seek to shape policies and practices in non-health sectors that promote health and health equity. Within the health care system, there are multi-payer federal and state initiatives, and Medicaid-specific initiatives focused on addressing social needs. These include models under the Center for Medicare and Medicaid Innovation, the Medicaid delivery system, and payment reform initiatives and options under Medicaid. Managed care plans and providers also identify and address social needs (Anna Spencer, 2016). For example, 19 states required Medicaid-managed care plans to screen for and provide referrals for social needs. A recent survey of Medicaid-managed care plans found that almost all (91%) responding programs reported activities to address social determinants of health (Spencer A. et al., 2016). In addition to the growing movement to incorporate health impact/outcome considerations into non-health policy areas, there are also emerging efforts to address non-medical, social determinants of health within the context of the healthcare delivery system (Bachrach, D. et al., 2018). These include multi-payer federal and state initiatives, Medicaid initiatives led by states or by health plans, and provider-level activities focused on identifying and addressing their patients’ non-medical and social needs. According to Bacharach et al. (2018), within Medicaid, the growing focus on social determinants of health raises new questions about the appropriate role Medicaid should play in addressing non-medical determinants of health and how to incentivize and engage Medicaid MCOs in addressing social determinants of health.
Anna Spencer, Bianca Freda, and Tricia McGinnis, Center for Health Care Strategies, and Laura Gottlieb, MD, University of California, San Francisco, Measuring Social Determinants of Health among Medicaid Beneficiaries: Early State Lessons (Hamilton, New Jersey: Center for Health Care Strategies, Inc., Dec. 2016), https://www.chcs.org/media/CHCS-SDOH-Measures-Brief_120716_FINAL.pdf.
Deborah Bachrach, Jocelyn Guyer, Sarah Meier, John Meerschaert, and Shelly Brandel, Enabling Sustainable Investment in Social Interventions: A Review of Medicaid Managed Care Rate-Setting Tools (New York, New York: The Commonwealth Fund, Jan. 2018), http://www.commonwealthfund.org/~/media/files/publications/fund-report/2018/jan/bachrach_investment_social_interventions_medicaid_rate_setting.pdf.
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