Advocates for Evidence-Based Health Policy Speakers
Social Determinants of Health in Medicaid
The World Health Organization defines social determinants of health (SDOH) as the conditions in which individuals are born, grow, live, work, and age. SDOH are increasingly recognized as having a critical impact on individual health risks and outcomes. The Centers for Disease Control and Prevention and Healthy People 2020 provide resources for SDOH data as well as literature and tools to facilitate program development and policy change.
State Medicaid programs “design, implement, and co-fund public health insurance systems for low income individuals,” who are more most likely to have high unmet social needs. Medicaid programs are uniquely positioned to help determine how payers, clinicians, and systems address SDOH and achieve health equity.
The Medicaid Medical Directors Network (MMDN) contains 42 member states and was designed to advance the health of Medicaid patients. The MMDN was surveyed by Chisolm et al. with a response rate of 40.5%. More than half of respondents endorsed that they were collecting and using SDOH data for their Medicaid programs and all respondents intended to start or continue collection of such data in the future. Housing instability and food insecurity were the most often cited SDOH data collected while data pertaining to criminal justice and domestic violence were among the least collected.
In order to advance approaches to SDOH and inform policies the authors suggest the following calls to action:
- Develop of validated measures of SDOH related risks and outcomes
- Reconsider privacy and confidentiality policies that block individual level data sharing within and across agencies
- Develop pilot or demonstration projects that allow spending across health and social service silos
- Develop infrastructure and funding mechanisms allowing states to share best practices
The survey and interview data presented represent fewer than half of state and territorial Medicaid programs. Despite the limitations, the authors identified state Medicaid agencies’ priorities regarding SDOH and provide new insights pertaining to factors influencing states’ ability to reach their goals.
Many state Medicaid programs, which cover the healthcare costs of millions of low-income Americans, report currently using or planning to use SDOH data to address some of the underlying social constructs driving health care expenditures despite barriers to implementation and sustainability.
This Health Policy Journal Club review is a collaboration between Policy Prescriptions® and the Emergency Medicine Residents’ Association. It is written by Brittney Mull, MD, MPH. She is an emergency medicine resident at Harbor UCLA Medical Center.
Abstract
BACKGROUND: 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. This paper explores states’ current approaches to SDH.
METHODS: A 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.
RESULTS: Seventeen 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.
CONCLUSION: These 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.
PMID: 30871510
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