Over the past few years, states have begun encouraging collaborations between medical, behavioral health, and social service providers in order to drive whole person care and address the social determinants of health. The “social determinants of health” include a combination of non-clinical factors affecting health such as personal, family, economic, and social circumstances. By broadening the focus beyond medical care, states are better positioned to improve outcomes and control costs for vulnerable Medicaid populations.
The outgoing administration through the Affordable Care Act has been a driving force for improving community health, leaving many wondering about the future of healthcare once President-elect Trump takes office. Though there will almost certainly be changes, including a repeal of all or part of the ACA, the focus on improving community health will continue. Given the often overwhelming prevalence of social needs facing Medicaid populations, such as housing, transportation, and nutrition, aligning healthcare delivery and social services is critical.
Nine states have developed Medicaid Accountable Care Organization models in order to better address care coordination for their communities. Ten more are in the planning stages. While each state program is unique, all of them are building capacity for ACO social service integration in order to provide infrastructure for collaboration between multiple medical and social service providers. States are using three main levers to support these collaborations:
- Program and Governance Requirements
- Financial Incentives
- Data-sharing Infrastructure
Program and Governance Requirements
One important way states foster social service and healthcare integration is through program and governance requirements. All Medicaid ACO programs wishing to participate are required to form partnerships with external entities, such as behavioral health, substance abuse, nutrition assistance, and housing. For example, Oregon’s ACOs must have agreements with particular emergency and mental health programs. Maine requires that its ACOs develop relationships with at least one public health entity and at least one provider of targeted case management services. Minnesota’s IHPs must include formal partnerships with community-based organizations, public agencies, and social service agencies in their delivery model. This use of non-traditional providers for care coordination also allows community health workers to bill Medicaid directly for some of their services.
Financial incentives are a powerful vehicle for driving closer collaboration between ACOs and community-based providers. Though each state has unique payment models that connect social services and healthcare providers, two common types are Shared Savings and Global Payments. Minnesota and Vermont both use shared savings arrangements. Minnesota’s IHPs are allowed to include social services or other non-traditional services within the total cost of care calculation for eligible patients. Minnesota also awards bonus points for IHPs that include community organizations, local public health entities, and/or behavioral health and long-term care providers in distribution of shared savings and loss payments. Vermont has adopted an “encourage-incent-require” approach for calculating the total costs of care for eligible patients over a three-year period. In the second year ACOs can increase their shared savings rate from 50 to 60 percent by assuming accountability for additional services, such as non-emergency transportation.
Oregon’s CCOs, on the other hand, are regional entities that accept a single global budget and are accountable for the cost and quality of Medicaid beneficiaries’ physical, behavioral, and dental health. Through the global budget, CCOs can include Medicaid-covered services and non-traditional services to coordinate whole-person care. Each year (beginning in 2013) an increasing percentage of a CCOs global budget is withheld but can be recovered by meeting quality targets. This strategy encourages providers to coordinate with other sectors in order to meet these targets.
Data sharing is one of the most critical aspects driving community health as it enables medical and community providers to facilitate effective patient transitions and monitor long-term outcomes. Success depends on states investing in technology infrastructure which links information and delivers a seamless experience across agencies and disciplines. For example, Washington developed an integrated social service client database that fosters collaboration amongst state agencies and allows states to identify patient risks, costs, and outcomes at the state, individual, and family level.
With Republicans controlling the White House and both houses of Congress, change is inevitable for state Medicaid programs. However, initiatives to improve community health through collaboration between medical, behavioral health, and social services will continue to move forward as the entire industry shifts towards value-based healthcare. Eccovia Solutions is proud to be a part of this movement. We are partnering with Community Health Partnership – the community coalition managing Region 7 of Colorado’s Regional Care Collaboratives – to provide an integrated care software system. Our ClientTrack Care Coordination platform will be used by CHP and its clients to more easily access medical and behavioral services, as well as support services such as transportation and housing.