Value in Medicaid, part 2: Challenges concerning health-related social needs

Following implementation of the Affordable Care Act, the Department of Health and Human Services established ambitious goals in Medicare for linking fee-for-service (FFS) payments to quality and value and transitioning more Medicare payments to models that move away from FFS. As a result, the Centers for Medicare and Medicaid Services (CMS) initiatives to stand-up and accelerate value-based purchasing (VBP) and alternative payment models (APMs) within Medicare have garnered most of the attention in academic and policy arena discussions on value in health care.

Meanwhile, in Medicaid, the nation’s public health insurance program for people with low income, CMS and some states are testing modified reimbursement schemes to incentivize quality and begin promoting value. Results emerging from these demonstrations as well as the COVID-19 pandemic show us that the journey to value for Medicaid beneficiaries presents unique challenges that will require different programmatic and health system approaches within the health care sector, effective partnerships with the social services sector to meet individual-level health-related social needs (HRSN), and, crucially, greater societal investments addressing community-level social determinants of health (SDoH).

Part one of this two-part post addressed the administrative, regulatory, and financial challenges along the journey to value in Medicaid. Part two addresses challenges concerning health-related social needs.