Enabling sustainable investment in social interventions: a review of Medicaid managed care rate-setting tools

Enabling sustainable investment in social interventions: a review of Medicaid managed care rate-setting tools

Collection:
Health Policy and Services Research
Author(s):
Bachrach, Deborah, author
Guyer, Jocelyn, author
Meier, Sarah, author
Meerschaert, John, author
Brandel, Shelly, author
Contributor(s):
Commonwealth Fund, issuing body.
Publication:
[New York, N.Y.] : Commonwealth Fund, January 2018
Language(s):
English
Format:
Text
Subject(s):
Managed Care Programs -- economics
Medicaid -- economics
Social Determinants of Health
Social Support
Socioeconomic Factors
Insurance, Health, Reimbursement
Reimbursement Mechanisms
Reimbursement, Incentive
State Government
Value-Based Purchasing
Humans
United States
Genre(s):
Technical Report
Abstract:
ISSUE. It is widely recognized that social factors, such as unstable housing and lack of healthy food, have a substantial impact on health outcomes and spending, particularly with respect to lower-income populations. For Medicaid, now dominated by managed care, this raises the question of how states can establish managed care rates to sustain investments in social supports. GOAL. To explore practical strategies that states can deploy to support Medicaid managed care plans and their network providers in addressing social issues. METHODS. Literature review, interviews with stakeholders, and analysis of federal regulations. FINDINGS AND CONCLUSIONS. We identify the following options (1) classify certain social services as covered benefits under the state's Medicaid plan; (2) explore the additional flexibility afforded states through Section 1115 waivers; (3) use value-based payments to support provider investment in social interventions; (4) use incentives and withholds to encourage plan investment in social interventions; (5) integrate efforts to address social issues into quality improvement activities; and (6) reward plans through higher rates for effective investments in social interventions. More needs to be done, however, to assist interested states in using these options and identifying pathways to braid Medicaid dollars with other social services funding.
Copyright:
Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)
Extent:
1 online resource (1 PDF file (19 pages))
Illustrations:
Illustrations
NLM Unique ID:
101722900 (See catalog record)
Permanent Link:
http://resource.nlm.nih.gov/101722900