POPULATION HEALTH MANAGEMENT · SOCIAL DETERMINANTS OF HEALTH
and costs,” Ferguson adds. “We’re seeing that in the contracts now: partnerships with housing organizations have become really commonplace.” States also are beginning to gather data
on these efforts in order to make the case for more funding and flexibility in terms of what Medicaid is allowed to pay for. Jami Snyder, who oversees Medicaid and CHIP as director of the Arizona Health Care Cost Containment System, says the state has seen
improved Jami Snyder
health outcomes among pat ients who have received supportive housing funding. In its 1115 Medicaid waiver renewal request to the Centers for Medicare &
Medicaid Services (CMS), Arizona is ask- ing for federal matching funds to extend that type of housing support. For the past several years, the Arizona
Legislature has allocated about $3 mil- lion per year for rental assistance, which is combined with wrap-around services paid for by Medicaid. Snyder says the results are impressive. “For 2020, when we looked at that population of individuals, which was just under 2,500 members, we saw a 31 percent reduction in emergency department visits, a 44 percent reduction in inpatient admits, and a savings of just over $5,500 per member per month. We’ve had a lot of productive conversations with state policymakers, once we’re able to show them that data. The data about ED visits and inpatient stays points to better health outcomes as well as a reduction in cost.” She says the state’s Medicaid managed
care program “can be more impactful when we stabilize someone’s housing with those wraparound supports than we can with any clinical intervention.” It its current 1115 waiver renewal
request to CMS, Arizona is seeking to extend its work in the housing space to include supports that historically have only been offered to members who qualify for long-term care, such as home modifications and community transition services that pay for things like first and last month’s rent, and basic furnishings to get someone set up in an apartment. “Under our Housing and Healthcare Opportunities (H2O) demonstration requests,” Snyder adds, “we’re also asking for the ability to reimburse for transitional
Paying for non-medical services in North Carolina CMS has authorized up to $650 million in Medicaid funding for pilot projects in North Carolina, which will cover the cost of delivering non-medical services and, in the first two years, support capacity building for human service organizations needed to effectively deliver non-medical services in a healthcare context. In 2022 North
Carolina has begun rolling out what it calls its “Healthy Opportunit ies” pilots
in phases, Amanda Van Vleet
with food services going live in March, housing and trans- portation services in May, and toxic stress
services in June, says Amanda Van Vleet, associate director for innovation for North Carolina Medicaid. Through Healthy Opportunities, orga-
nizations that provide services related to nutrition and food assistance, transporta- tion, housing and interpersonal safety can receive payments for services they provide to Medicaid patients. The Healthy Opportunities program is
being co-managed by the state-contracted managed care organizations and regional network lead organizations. “They play different roles in that the health plans are responsible for making sure that members that receive pilot services are eligible for them, authorizing the services that they receive, to make sure that they’re appropri- ate, and managing the pilot budget,” Van Vleet explains. The health plans are also ultimately accountable for care manage- ment for pilot enrollees, whether they do that in house or through a local advanced medical home. The network leads form the networks of human service organiza- tions, provide technical assistance to them, and help them with invoicing. They’re
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services, so we can better coordinate care when individuals are leaving our correc- tional settings as they transition back out into the community.” Arizona also is asking CMS for the
ability to pay for outreach services — in particular outreach to homeless popula- tions. “Providers have found that outreach is really instrumental to engaging folks and getting them into care, and then ulti- mately transitioning them into permanent supportive housing,” Snyder says.
responsible for monitoring and program integrity and ensuring quality services are delivered. It can be difficult to assess the impact of
the interventions just because the services being provided address some issues far upstream, Van Vleet noted. For instance, services that address adverse childhood experiences for young children may take a longer period of time to show an impact. “But there is a good amount of evidence out there that food, housing and trans- portation impact health outcomes and cost, so we’re hoping to improve on that evidence base.” Van Vleet says the rollout has seen both
successes and challenges. It’s a new pilot program, so all of the stakeholders — health plans and network leads, the clini- cal providers, the human service orga- nizations, the state government — are taking on new work and responsibility for the program. “The primary feedback we’ve heard is extremely positive,” she stresses. “It is truly an ecosystem model we have, with five health plans, five clinically integrated networks, three network leads, and around 100 human service organizations. The health and social sectors historically haven’t really worked together and communicated with one another. We’re really seeing collabo- ration and partnerships that are growing. We’ve created this technology system to link the medical and non-medical sectors, and we have established an additional and predictable funding source to invest in local human service organizations. We’re getting data that we’ll be able to evaluate. Over 1,700 members have been served so far, and over 800 services have been delivered.”
Washington’s Accountable Communities of Health In the State of Washington’s Medicaid transformation, which began in 2017, regional Accountable Communities of Health partner with managed care orga- nizations. The MCOs have membership on each of the ACH boards. “I think that the Accountable Communities of Health really have a critical role on the ground in the communities, connecting with those community partners and other social service providers to help with actual client needs. That role is different than the medical care that they’re receiving from the MCOs,” says Mich’l Needham, chief policy officer with the state’s Health Care Authority.
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