Addressing Health-Related Social Needs Through Medicaid Managed Care

On Thursday, July 27, our CEO and Co-Founder, Sebastian Seiguer, participated in the panel, “Addressing Health-Related Social Needs Through Medicaid Managed Care,” at the Medicaid Leadership Innovation Strategies Conference.

He was joined by moderator Kalin Scott, a Senior Advisor at the Helgerson Solutions Group, and panelists: Karen Dale, the CEO of AmeriHealth Caritas DC and the Chief DEI Officer of AmeriHealth Family of Companies; Shannon Dowler, the Chief Medical Officer of North Carolina Medicaid, NC Department of Health and Human Services; and Dr. Chris Esguerra, the Chief Medical Officer of the Health Plan of San Mateo.

Here are our top takeaways from their conversation. 

‍Social determinants of health (SDOH) heavily impact population health outcomes, and the right interventions can play an important role in alleviating SDOH-related barriers to health.

‍Our work started about a decade ago with deep connections, listening to our enrollees, providers, and stakeholders. In that listening, we found a number of things that connected. There were barriers that could be addressed. Food insecurity, transportation. People are working, and provider office hours can be a barrier. Health literacy is also an SDOH; however, we don’t focus enough on it. When we started listening and identifying outliers and barriers, it accelerated our progress to shift things. A focus on food insecurity and better nutritional choice information [was a part of that]. [Helping people with] not just knowing what to eat but how to shop and prepare foods. We have a dozen very mature interventions that are evaluated every two years. We are now refining. A centerpiece of our work is who we serve. — Karen Dale, the CEO of AmeriHealth Caritas DC and the Chief DEI Officer of AmeriHealth Family of Companies

When we first started in public health, we found that to solve adherence, you have to make sure patients have food, can get to the clinic, you may need to get them a cellphone, and, of course, they have to get medication. That's the medication adherence journey. It's much more than simply taking medication correctly every day. —Sebastian Seiguer, CEO and Co-Founder, Scene Health

With Section 1115 waivers, states can test new interventions in Medicaid that contribute meaningfully to alleviating SDOH.

North Carolina started 7-8 years ago. We developed the first statewide closed-loop referral system. Any member of a community organization could submit their needs and get help connecting to resources. We identified a standardized screening tool for SDOH. Our data is not great yet, but we’re getting there. The [1115] waiver was $650M to invest in 29 evidence-based benefits that are not medical in 3 regions as a pilot. There are carve-outs for special needs and family planning. Our goal is to improve health and value and save money by making better outcomes happen. Then study that and see what makes a difference and what doesn’t. — Shannon Dowler, the Chief Medical Officer of North Carolina Medicaid, NC Department of Health and Human Services 

Community Based Organizations (CBOs) are trusted entities that are deeply embedded within the communities they serve, and they have a key role in improving the healthcare delivery system. Effective partnerships and contracts between healthcare organizations and CBOs are an important way to improve the overall health and well-being of individuals and communities.

‍Our work with CBOs…I call it career-defining. The shift is all around power, trust, and humility. What we’ve done is gone to find willing partners, and we treat them as such. We’re not trying to diminish their mission or force them into a managed care mode. — Karen Dale, the CEO of AmeriHealth Caritas DC and the Chief DEI Officer of AmeriHealth Family of Companies

One thing I really want to underline is power dynamics. Understanding that we, the payer, have the leverage, we have the money. The CBOs have the trust they know the community. — Dr. Chris Esguerra, the Chief Medical Officer of the Health Plan of San Mateo.

There are some challenges. These organizations are often very small and organic, and they live off grant dollars. It’s really difficult for them to understand healthcare billing. But you want results and results fast. A bigger vendor can do the thing and do it quickly, but a smaller organization is more in the community but takes longer to build up. — Shannon Dowler, the Chief Medical Officer of North Carolina Medicaid, NC Department of Health and Human Services 

Data plays a powerful role in the ability of healthcare organizations to address SDOH and improve population health outcomes, but we need to pay attention to how the data is collected.

The fact is that it’s not enough to only gather the data that proves your intervention works for its outcomes. But how does that link to AMR, for example? At the individual level, that doesn’t win the day. You have to marry two data sources. The larger outcome and data about what you did specifically. Managing the sources is not easy, especially because claims data is slow. —Sebastian Seiguer, CEO and Co-Founder, Scene Health

Data is great, but it’s much harder to measure the “so what.” What did that do for them? It takes so long to get meaningful value-based outcomes. And the piece around screenings, I would caution everyone we’ve overwhelmed the provider world with screenings. There’s [also] a lot of shame for people acknowledging they can’t feed their families or themselves or provide transportation. Who is asking the questions? Do they trust the person? If not, I guarantee they’re not answering the questions fully. I guess data is a mixed blessing. We should measure everything. What are we doing with the data, and is it meaningful? — Shannon Dowler, the Chief Medical Officer of North Carolina Medicaid, NC Department of Health and Human Services 

There is an intention of over-collecting. But in that, you’re imposing a burden on all parts of the system and, ultimately, the individuals you want to serve. I do think there might be some interesting creativity in what other data sources we want to measure that get to what we want to solve. We have close partnerships with county behavioral health systems to get more data. How can you get creative cross-divisions across sectors to get to what you need and be able to actually use it? Amazon has done a great job telling me I need those new sneakers before I know I need them. We should probably get to something like that. — Dr. Chris Esguerra, the Chief Medical Officer of the Health Plan of San Mateo.

With the maturity of most of our Medicaid programs, we should be doing a lot more to mine data and create profiles and more predictive space. With the wealth of data that already exists, we could do a better job of predicting. We know that equity matters. When it comes to collecting race and ethnicity, self-reporting is best, but we should use predictive to fill in the blanks. — Karen Dale, the CEO of AmeriHealth Caritas DC and the Chief DEI Officer of AmeriHealth Family of Companies

We left the conversation energized by the panelist's commitment to improving population health outcomes by using data, community connections, and evidence-based interventions to address SDOH. 

Contact us to learn about our work helping patients make dramatic improvements to their health through a comprehensive medication engagement program that leverages the power of data, trust, and daily connections to efficiently identify, understand, and tackle SDOH.