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A Social ACO for Medicaid managed care

Batniji R, Agrawal S, Ma S, Basu S
Health Affairs Forefront

Numerous studies have shown that the failure to address individuals’ housing, food, transportation, and other health-related social needs (HRSNs) can result in poorer health outcomes and increased health care costs. Elizabeth Bradley and colleagues have published several empirical research studies and a book illustrating that the underinvestment in social services relative to health care, at least in part, explains why the United States has worse health outcomes compared to other developed countries. In the absence of broader social welfare programs, the burden of trying to address HRSNs often falls on health care stakeholders, especially providers and payers.

Here, we propose an alternative value-based arrangement: a “social accountable care organization” (ACO) for Medicaid managed care that addresses social needs by placing primarily non-clinical staff at the center of care to maximize the impact on the well-being and health of beneficiaries. A social ACO is funded by a value-based arrangement with a Medicaid health plan and works with existing Medicaid providers to facilitate access to care. However, unlike conventional ACOs, a social ACO is guided by a non-clinical resource at the center focused on addressing social needs, as well as better connecting individuals to clinical care when needed. Unlike similar approaches to implementing a social ACO, which rely primarily on clinical staff to screen patients for social needs, we argue that enlisting a provider enablement organization with expertise in coordinating social services is a more effective approach.

Batniji R, Agrawal S, Ma S, Basu S. A social ACO for Medicaid managed care. Health Affairs Forefront. October 17, 2023. DOI: 10.1377/forefront.20231011.560489

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