Measuring Social Determinants of Health among Medicaid Beneficiaries: Early State Lessons

From the policy brief  by Anna Spencer, Bianca Freda, Tricia McGinnis, and Laura Gottlieb of the Center for Health Care Strategies, Inc.:

Social determinants of health (SDOH) are conditions in the environment in which people are born, live, learn, work, play, worship, and age that affect health outcomes and risks, functioning, and quality-of-life. These social, economic and environmental conditions, in addition to health behaviors, relate to an estimated 80 percent of health outcomes in the United States. Moreover, behavioral patterns/health-risk behaviors (40%), social circumstances (15%), and environmental exposures (5%) play a significant role in premature death in this country (Exhibit 1). These determinants of health disproportionately affect those in low-income brackets.

Given Medicaid’s role in serving people with complex clinical, behavioral health, and social needs, state Medicaid agencies are uniquely positioned to identify and help address these diverse social challenges. In recent years, many of these agencies have developed strategies to support providers in addressing patients’ SDOH that complement more traditional medical care delivery programs. Some state Medicaid agencies have started to integrate coverage for interventions focused on SDOH into new value-based payment models. Many Medicaid managed care organizations (MCOs) are also developing interventions that address SDOH by linking clinical and non-clinical service delivery to improve health outcomes and cost efficiencies. At the federal level, the Center for Medicare and Medicaid Innovation (CMMI) is planning to test whether Accountable Health Communities (AHC) are a cost effective approach to identifying and addressing select unmet social needs of Medicare and Medicaid beneficiaries across the country.

Collecting information on social risks — including access to food and housing and employment status — is a key component of developing and implementing interventions to address these risks. Select providers and health care organizations are pioneering strategies to collect and use patient-level SDOH information to better direct interventions. These efforts, however, are not universal. Medicaid can play a key role in driving consistent measurement, collection, and use of SDOH data among health plans and providers. Little is known, however, about Medicaid and public health efforts to assess SDOH among Medicaid beneficiaries, including the degree to which standardized SDOH measures are used.

Building on previous CHCS work on health-related supportive services in Medicaid, CHCS sought to learn more about SDOH data collection by Medicaid and other state agencies, including whether there was any standardization across programs and how the data was being used. CHCS conducted interviews with more than 30 key informants representing eight states, as well as the Center for Medicare and Medicaid Innovation, the Association for Community Affiliated Plans, and a Medicaid MCO to better understand how states collect and apply beneficiary SDOH data. These interviewees represented diverse perspectives, including Medicaid and public health department officials, metrics managers, and experts in data analysis, health information policy, and informatics. Drawing from the interviews, this brief explores: (1) how states define and collect patient-level SDOH information; (2) processes for measures selection; (3) the multi-pronged ways Medicaid and other state agencies are using SDOH data at the patient and population level; (4) challenges to capturing and using SDOH data; and (5) key considerations for Medicaid in advancing SDOH measurement approaches. The information gleaned from the interviews offer valuable early lessons to help policymakers and researchers drive greater and more consistent collection of patient level SDOH information.

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