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'Common Practice': State Medicaid Programs Require MCOs to Address SDOH

Analysis  |  By Jack O'Brien  
   October 22, 2020

The Manatt Health survey found that care management is the most common approach while financing initiatives are the "most leading edge."

A Manatt Health survey released Thursday morning indicated that it is now "common practice" for state Medicaid programs to require managed care organizations (MCOs) to address social determinants of health (SDOH).

The survey found that care management is the most common approach to addressing SDOH while financing initiatives are the "most leading edge."

Most state Medicaid programs direct MCOs to target vulnerable communities for SDOH interventions, according to the survey, primarily focusing on women, children, and members with high needs.

Related: Beaumont Health VP of Managed Care on Driving Value in the Pandemic

Manatt broke down the common practices, emerging practices, and leading-edge practices used by MCOs to address SDOH:

Most common practices:

  • Screening or assessing populations for social needs
  • Referring to social services
  • Coordinating with other state and federal programs
  • Coordinating social needs

Related: Key Advice for Hospital CFOs Facing Next Stages of Pandemic

Emerging practices:

  • Training on SDOH for staff
  • Reporting on SDOH initiatives

Leading edge financing practices:

  • Using SDOH-related withholds or incentive payments
  • Leveraging value-based payment to incent SDOH interventions
  • Using SDOH-related in-lieu-of/value-added services
  • Risk-adjusting for social factors

"This pandemic—and its disproportionate impact on low-income communities and communities of color—has brought the need to address SDOH into sharp focus," Melinda Dutton, partner with Manatt Health and coauthor of the report, said in a statement.

Despite the efforts made to impact vulnerable patient populations, only 16 states are leveraging Section 1115 waivers in "innovative ways," according to Manatt.

Related: Social Determinants of Health: Lead or Partner

Jack O'Brien is the Content Team Lead and Finance Editor at HealthLeaders, an HCPro brand.

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