medicaid managed care and social determinants of health ...jun 25, 2019 · determinants of health...

Medicaid Managed Care and Social

Determinants of Health Workgroup

Kick-Off WebinarJune 25, 2019

A grantee of the Robert Wood Johnson Foundation

State Health Value Strategies | 3

About State Health Value StrategiesState Health and Value Strategies (SHVS) assists states in their efforts to transform health and health care by providing targeted technical assistance to state officials and agencies. The program is a grantee of the Robert Wood Johnson Foundation, led by staff at Princeton University’s Woodrow Wilson School of Public and International Affairs. The program connects states with experts and peers to undertake health care transformation initiatives. By engaging state officials, the program provides lessons learned, highlights successful strategies, and brings together states with experts in the field. Learn more at www.shvs.org.

Questions? Email Heather Howard at [email protected].

Support for this webinar was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.

http://www.shvs.org/mailto:[email protected]


Welcome from State Health and Value Strategies (SHVS)

Dan MeuseDeputy DirectorState Health and Value Strategies [email protected]


Housekeeping Details

• The participant lines are unmuted. Please mute yourself through your phone or computer when you are not talking to minimize background noise.

• After the webinar, the slides and a recording will be available at www.shvs.org on a password-protected site.


Bailit Health’s Team for the WorkgroupKate BazinskySenior ConsultantBailit [email protected]

Michael BailitPresidentBailit [email protected]

Rachel IsaacsonConsultantBailit [email protected]


Agenda

1. Workgroup goals 2. Introductions3. Workgroup content and calendar4. Virtual office hours5. Next steps


Workgroup Goals

• Provide a forum for participants to:– Discuss Medicaid managed care social

determinants of health (SDOH) efforts;– Learn from expert faculty, and – Share their challenges and lessons learned

• Participating states:– AZ, DC, HI, IN, MA, NY, OR, RI, TN


Arizona• # of enrollees in Medicaid Managed Care: 1.9 million • Team members

– Jami Snyder, Director– Shelli Silver, Deputy Director for Health Plan Operations– Dara Johnson, Program Development Officer– George Jacobson, Project Manager, Targeted Investments Program– Susan Podshadley, Senior Clinical Project Manager

• #1 reason why our state is addressing SDOH– Current efforts, particularly in the housing arena, have demonstrated success in

improving health outcomes and driving down total cost of care– Interested in establishing a systemic approach to SDOH efforts which integrates

identification, referral and fulfillment into established workflows

• Current SDOH initiatives– MCO contract requirements related to housing and employment staffing– Provide full range of supportive housing and employment support services – Administer rental subsidy fund ($30M) and housing development/rehab fund ($2M)– Maintain 13 Justice Clinic sites throughout state– Require MCOs reinvest 6% of profit in community


District of Columbia• # of enrollees in Medicaid Managed Care: 188,545• DC DHCF team members

– Lisa Truitt, Director, Health Care Delivery Management Administration– Erin Holve, Director, Health Care Reform and Innovation Administration– DaShawn Groves, Lead Project Manager, Health Care Reform and Innovation– Carleta Belton, Special Projects Coordinator, Health Care Delivery Management

Administration• #1 reason why DC is addressing SDOH

– The implementation of VBP programs in the District has increased the need to support practice transformation approaches that integrate social needs in order to improve health outcomes.

• Current SDOH initiatives– MCOs providing added value services:

• Member Wellness Centers offering literacy/GED courses, exercise, cooking and nutrition classes

• Home meal delivery programs• Mail order diapers, breastfeeding support and supplies, and safe sleeping kits for

expecting mothers• Tax preparation and financial wellness• Partnering with Downtown Day Services Centers for individuals experiencing

homelessness– DHCF implementing innovative technical solutions to SDOH screening, referral, and follow-

up through the Community Resource Information Exchange (CoRIE) Project


Hawai‘i• # of enrollees in Medicaid Managed Care: 340,000• Team members

– Judy Mohr Peterson, Med-QUEST Division Administrator– Jon Fujii, Health Care Services Branch Administrator – Jackie Indreginal, Quality an Member Relations Section Administrator– Joy Soares, Program Specialist V– Ranjani Starr, Health Analytics and Informatics Administrator– Additional subject matter experts will participate as well

• #1 reason why our state is addressing SDOH– SDOHs have a major impact on health outcomes, especially for vulnerable

populations.

• Med-QUEST Division’s (MQD) approach to SDOH– to develop integrated solutions within the context of the health care delivery

system so enrollees receive services that improve their health and well-being.

• Current SDOH initiatives– Med-QUEST will develop a SDOH Transformation Plan in coordination with other

state agencies– Implement requirements in new MCO contract– Further explore adjusting for SDOH risks when developing rates


Indiana • # of enrollees in Medicaid Managed Care: 1,433,090

• Team members– Allison Taylor, Indiana Medicaid Director– Meredith Edwards, Quality and Outcomes Section Director, Medicaid– Amy Gilbert, Chief Science Officer, Family and Social Services Administration– Dan Rusyniak, Chief Medical Officer, Family and Social Services Administration

• #1 reason why our state is addressing SDOH– To help Hoosiers more fully engage with their communities to achieve optimal

emotional, mental, and physical wellbeing

• Current SDOH initiatives – Online social needs assessment for persons applying to Medicaid/SNAP/TANF– Employee engagement campaign on SDOH awareness and empathic inquiry– Partnering with MCOs, health systems, and academia to design coordinated

SDOH initiatives addressing identified needs


Massachusetts • # of enrollees in Medicaid Managed Care: ~879,000 in ACOs• Team members

– Allison Rich, Program Manager, Social Services Integration, MassHealth– Stephanie Buckler, Esq., Deputy Director, Social Services Integration,

MassHealth– Clara Filice, MD, MPH, MHS, Senior Medical Director, MassHealth

• #1 reason why our state is addressing SDOH – MassHealth is committed to improving member outcomes and reducing Total

Costs of Care. SDOH provides an innovative and unique opportunity to meet these goals

• Current SDOH initiatives – MassHealth includes SDOH variables in risk adjustment for financial benchmarks

and certain utilization measures.– MassHealth ACOs are screening all members for Health-Related Social Needs

(HRSN) yearly. If need arises, ACOs must address need.• ACOs are held accountable based on a quality measure

– MassHealth set to launch Flexible Services Program in January 2020. Flexible Services is a focused program piloting whether MassHealth ACOs can reduce TCOC and improve members’ health outcomes by implementing targeted evidence-based programs that address certain eligible members’ HRSN.


New York

• # of enrollees in Medicaid Managed Care: 4.7 million

• Team members – Elizabeth Misa, Deputy, Office of Health Insurance Programs (OHIP), DOH– Denard Cummings, Director, Bureau Social Determinants of Health, OHIP, DOH– Emily Engel, Deputy Director, Bureau Social Determinants of Health, OHIP, DOH– Martina Ahadzi, Bureau Social Determinants of Health, OHIP, DOH

• #1 reason why our state is addressing SDOH– Improve health outcomes/lower avoidable Medicaid costs

• Current SDOH initiatives – Supportive Housing Program for high-cost Medicaid members– Value-based payment programs for SDH initiatives– Pending Federal Waiver submission for housing-related services


Oregon• # of enrollees in Medicaid Managed Care: 845,000

• Team members– Chris DeMars, Transformation Center, Health Policy & Analytics Division– Anona Gund, Transformation Center, Health Policy & Analytics Division – Steph Jarem, Health Policy Office, Health Policy & Analytics Division– Lori Kelley, Behavioral Health/Housing Team, Health Systems Division– Amanda Peden, Transformation Center, Health Policy & Analytics Division

• #1 reason why our state is addressing SDOH– OR is addressing SDOH through its health system transformation efforts—

specifically, Coordinated Care Organizations (CCOs)—because we cannot achieve the triple aim otherwise


Oregon• Current SDOH initiatives

– Creating the Boosting Up Investment in Long-term Development for Social Determinants of Health and Equity (BUILD) Fund (incentive program) and Supporting Health for All through Reinvestment (SHARE) Initiative (reinvestment requirement)

– Increasing health-related services spending in alignment with Community Health Improvement Plans (CHPs) and directed by Community Advisory Councils

– Supporting CHP alignment across CCOs, local public health authorities, and hospitals, and with the State Health Improvement Plan

– Developing a proposed SDOH-focused incentive metric, with a likely focus on SDOH screening and referral

– Supporting a statewide infrastructure for SDOH screening and referral– Increasing access to housing through funding for Permanent Supportive Housing,

Recovery Homes, and housing vouchers for individuals with severe and persistent mental illness; and technical support of housing support services

– Increasing adoption of value-based payments


Rhode Island • # of enrollees in Medicaid Managed Care: 301,110• Team members

– Ada Amobi, MD, Health Equity Institute, Department of Health– Chantele Rotolo, Quality Director, Medicaid– Deborah Correia Morales, Accountable Entity Program Director, Medicaid– Melody Lawrence, Director of Policy & Delivery System Reform, Medicaid

• #1 reason why our state is addressing SDOH– Improve individual and overall community health outcomes, reduce health care

costs, promote preventative and protective factors.– A key element of Medicaid valued-based purchasing strategy and complex care

management.

• Current SDOH initiatives – Current SDOH initiatives are part of a broader multipronged Medicaid managed

care strategy.• Policy Statement re: Risk Adjustment and Managed Care Rate setting process.• Health System Transformation & Medicaid Accountable Entity: Certification

Standards, Total Cost of Care/APM quality measure & incentive funding program.• Collaborative strategy in development with Rhode Island Department of Health

and other state agencies.


Tennessee• # of enrollees in Medicaid Managed Care: 1.4M• Team members

– Brooks Daverman, Chief Operating Officer– Keith Gaither, Director of Managed Care Operations– Jessica Hill, Director of Strategic Planning – Dr. Victor Wu, Chief Medical Officer

• #1 reason why our state is addressing SDOH– Addressing SDOH represents an opportunity to improve our members’ health.

TennCare’s mature managed care model is a great platform to build on.• Current SDOH initiatives

– MCOs have been authorized to pursue cost effective alternatives for 25 years. – MCOs are required to incorporate SDOH data into their assessment of members

risk for targeting case management. – Employment and Community First Choices provides supports for people with

intellectual and developmental disabilities to work and participate in their community.

– Health Home care coordination program for members with significant behavioral health needs pays providers rewards based on quality and efficiency measures (can include coordination with social supports).


Workgroup Content and CalendarDate Format Content

July 25-26, 2019 In-person convening in Chicago

Understanding SDOH and the strategy choices states possess

September 17, 2019 Webinar: 1 hour

Strategies for contracting with MCOs to address SDOH

October 15, 2019 Webinar: 1 hour

How to measure MCO performance in addressing SDOH

December 3, 2019 Webinar: 1 hour

Coordinating across state agencies and public programs

Mid-January2020

Webinar: 1 hour

Strategies for partnering with CBOs to address SDOH

Late February2020

Webinar: 1 hour

Community resource referral platforms options

April/May2020

Webinar: 1 hour

Topic TBD, workgroup wrap-up


Virtual Office Hours• Bailit Health will schedule virtual office hours.• The topics for the office hours will originate

from workgroup participants. • Once a topic has been identified, Bailit Health

will identify a relevant content expert, and inform workgroup participants of the scheduled day and time.

• Participation in virtual office hours will be at states’ discretion.


Other SDOH Topics of Interest?• Do you have any other topics, questions or concerns related to

SDOH that you would like to see addressed in the webinars or office hours?

• Sample topics: – SDOH domain-specific content, such as:

• Housing • Adverse childhood experiences (ACEs)• Other domains of interest?

– Data integration: connecting health care and social service data systems for analysis, evaluation, referral and risk-adjustment

– Relationship between SDOH and VBP– Risk adjustment – Data exchange and privacy

• Please reply in the chat box with any additional topics of interest or email Rachel ([email protected]) after the webinar.

mailto:[email protected]


Additional Resources

• As this workgroup unfolds, states may identify resource needs or tools that would be helpful in their work.

• Please email us with requests for additional resources.


Next Steps

• Please send any questions, comments, or potential future work group discussion topics to Rachel ([email protected]).

• July 25 and 26: In-Person Convening! – TheWit Hotel, 201 North State Street, Chicago – July 25: 7:45 a.m. to 5:00 p.m. (reception to

follow)– July 26: 7:45 a.m. to 12:30 p.m.

mailto:[email protected]


Thank You

State Health and Value Strategies | 24

Dan MeuseDeputy Director

State Health and Value [email protected]

609-258-7389www.shvs.org

Medicaid Managed Care and Social Determinants of Health WorkgroupMedicaid Managed Care and Social Determinants of Health WorkgroupAbout State Health Value StrategiesWelcome from State Health and Value Strategies (SHVS)Housekeeping DetailsBailit Health’s Team for the WorkgroupAgendaWorkgroup Goals ArizonaDistrict of Columbia�Hawai‘iIndiana Massachusetts New York OregonOregonRhode Island TennesseeWorkgroup Content and CalendarVirtual Office HoursOther SDOH Topics of Interest?Additional ResourcesNext StepsThank You

medicaid managed care and social determinants of health ...jun 25, 2019 · determinants of health...

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