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Implementing social determinants of health interventions in Medicaid managed care: How to leverage existing authorities and shift to value-based purchasing

T. McGinnis, D. Crumley, D. Chang
AcademyHealth & Nemours Children’s Health Systems

In 2017, Nemours Children’s Health System contracted with the Center for Health Care Strategies (CHCS) to work with the PacificSource Columbia Gorge Coordinated Care Organization (CCO), a regional Medicaid payer operating as the sole managed care organization in a rural area in Oregon, to identify sustainable financing mechanisms for the Bridges to Health Pathways Hub, which provides community service referrals and care coordination to residents in the Columbia Gorge area. This issue brief draws upon the practical lessons learned through that work and provides advice for state Medicaid agencies and managed care organizations (MCOs) interested in implementing similar SDOH strategies within managed care, by reflecting upon:

  • What existing Medicaid Managed Care authorities can be used to cover community care coordination and service delivery activities related to social determinants?
  • What incentives do MCOs have to invest in such programs?
  • What are innovative ways to pay for these services, in alignment with the broader shifts to value-based purchasing?

McGinnis T, Crumley D, Chang D. Implementing Social Determinants of Health Interventions in Medicaid Managed Care: How to Leverage Existing Authorities and Shift to Value-Based Purchasing. AcademyHealth and Nemours Children’s Health Systems; 2018. Available online.

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