How are Massachusetts community-based organizations responding to the health care sector’s entry into social determinants of health?

With a growing focus on population health and value-based care nationwide, the health care sector is increasingly recognizing the impact that social and environmental factors have on the health and health care utilization of low-income and other vulnerable populations. In Massachusetts, the state’s Medicaid program, MassHealth, is implementing a number of reforms as part of the Delivery System Reform Incentive Payment (DSRIP) program that was approved as part of the state’s most recent Medicaid 1115 demonstration waiver extension. MassHealth has also taken steps to address the social determinants of health (SDOH) through its care delivery reform efforts. Accountable care organizations (ACOs) are required to screen for health-related social needs in specified domains and are encouraged to refer patients with positive screens to local resources. The specific role of community-based organizations (CBOs) within the MassHealth ACO program is still in development.

This report aims to address the following question: How are CBOs responding to the health care sector’s movement into SDOH programming in Massachusetts? CBOs are de ned as nonprofit organizations that work at a local level to improve life for residents through direct service delivery and that are not focused primarily on health care promotion or delivery. The research team employed a key informant interview method to address the research question and conducted 46 interviews with leadership and high-level program staff from a diverse set of CBOs, including ones focused on food, housing, legal services, and more, across Massachusetts between September 2017 and March 2018. In analyzing more than 1,000 pages of resulting data, the research team identified five emergent themes.