A review of 10 recent state requests for proposals (RFPs) reveals new state-level approaches to addressing social determinants of health and health equity through their contracts with managed care organizations (MCOs).
Health Management Associates prepared the report, Medicaid Managed Care: Strategies to Address Social Determinants of Health & Health Equity, in partnership with Together for Better Medicaid, which along with its state-based chapters, is described as a multi-stakeholder, consensus-based group of patient advocates, clinicians, community-based organizations, health plans, providers, and other champions of Medicaid and Medicaid managed care.
The report notes that broader flexibility exists under managed care than fee-for-service to address social determinant issues, and that managed care provides the benefit of a single entity responsible for centralized care coordination. States can encourage or require managed care organizations (MCOs) to address SDOH and health equity via contract requirements. For instance, states can develop MCO reimbursement strategies such as performance withholds or bonuses with payments earned based on outcomes. Such arrangements create incentives for MCOs to adopt strategies addressing SDOH and equity.
Many states are requiring MCOs or provider networks to screen enrollees for SDOH needs, HMA found. Some are requiring MCOs to leverage technology in their SDOH screening efforts. For example, in Arizona, MCOs are required to utilize a statewide closed-loop referral system (CLRS) to refer enrollees to community-based organizations (CBOs) addressing SDOH. Therefore, the contract specifies that the screening tools MCOs encourage providers to utilize should be available through or compatible with the CLRS. Hawaii requires the MCOs’ information systems to support integration and facilitate predictive analytics to identify enrollees likely to benefit from special program services, including SDOH supports.
Some recent RFPs have included requirements for MCOs to incorporate SDOH in their quality assessment and performance improvement (QAPI) programs. States are increasingly requiring MCOs to coordinate with community-based organizations and ensure referrals to social services and supports. Recent RFPs have included requirements for MCO staff to address SDOH and for MCOs to provide training on SDOH to their staff.
Health equity requirements
The report notes that recent RFPs require MCO staffing to address health equity, as well as staff and provider training to address racial and ethnic disparities, diversity and inclusion.
States are requiring MCOs to develop cultural competency plans and to ensure culturally competent care management, marketing and MCO workforce.
A few states have incorporated health equity principles into their MCO pay-for-performance initiatives. Others are prioritizing health equity in the value-based payment arrangements MCOs implement with their provider networks.
For instance, Louisiana indicates the state may designate certain health equity-related tasks and/or benchmarks to be linked to a portion of the MCO performance withhold. To earn the withheld funds back, the MCO must submit the contractually required Health Equity Plan and the annual report must demonstrate progress on meeting health equity milestones and goals.
Minnesota MCOs are eligible for an adjustment to the risk corridor calculation if quality scores are met or exceeded. The measures have been selected to address and improve health care disparity gaps among MCO enrollees. Each measure is stratified by race and ethnicity and is assessed against a baseline disparity gap with the White population. Points are awarded for each measure in which the disparity gap is improved and deducted for worsened performance.
Some states also are prioritizing health equity in the value-based payment arrangements that MCOs implement with their provider networks.
