In 2020, the Center for Health Economics and Policy at the Institute for Public Health continued its efforts to build consensus on what strategies should be featured prominently in the State of Missouri’s efforts to transform its Medicaid program. The Center has compiled a set of ideas for transforming Medicaid payment, proposed by stakeholders, into a new white paper now published on the center’s website. The paper is entitled, “Recommendations for Missouri Medicaid transformation: Paying for value & prioritizing the social determinants of health.” The introduction points out, “the state is at a critical inflection point, with new opportunities to build innovative value-based payment models that center on the social determinants of health.”
The piece illustrates stakeholder feedback and ideas culminating from the event series, Transforming Healthcare in Missouri, hosted over the past three years by the Center and the Clark-Fox Policy Institute at the Brown School. In the fourth segment of the series, participants (which included providers, payers, consumers, researchers, advocates and policymakers) were divided into small groups and tasked with proposing innovative ways of paying for care, with a focus on improving health equity and addressing the social determinants of health.
“Solution Categories” were discussed and finalized at the event, and these are outlined in the paper’s the executive summary. Categories include: Expanding Primary Care Health Homes to include a greater number of Medicaid enrollees; hospitals receiving global budgets and serving as “health hubs”; moving additional Medicaid enrollees into managed care organizations; and, prioritizing a more coordinated and integrated approach to delivering social and behavioral health services by streamlining eligibility, funding and communication across programs. Read more about the “Solution Categories” in the paper’s Executive Summary.
Lauren Kempton, a Brown School practicum student who worked on the white paper extensively, discusses her biggest take-away from the project.
“What matters is not only whether people are insured, but also what their insurance will pay for, and what incentives are being created by that payment,” she says. “Patients on Medicaid are often dealing with additional health risks related to poverty, like a lack of stable housing, nutritious food, or transportation to get to their appointments. The idea at the core of this white paper is that changes in how Medicaid pays for services can lead to better care via better individual and system-level incentives for achieving good health outcomes.”
Kempton adds, “It’s surprising to me that our healthcare system, including Medicaid, routinely pays tens of thousands of dollars for something like a coronary bypass surgery while investing very little in the kinds of preventive care that could have avoided the need for the surgery in the first place. In the stakeholder discussions, ‘preventive care’ was imagined broadly. It could look like nutritional counseling, quality primary care and care coordination, or referrals to outside agencies that help meet people’s basic needs for food or housing. Because Medicaid is one of the largest payers in our healthcare system, Medicaid payment reforms have some real power to drive changes in the entire system of care—for the Medicaid population and potentially for other patients, too.”
Center for Health Economics and Policy Faculty Lead, Abigail Barker, talks about the importance of considering social determinants of health when addressing Medicaid transformation. “I think that addressing social determinants in the Medicaid program really means changing how and for what payments are made. When you designate a payment for something, then it is in the interest of health systems and social service providers to coordinate with each other to provide it. Right now, food insecurity is one of the most prevalent social needs, and it is one that has a strong, direct connection to individuals’ ability to manage their health. Referrals happen between health care providers and food banks, and some needs are met, but this is by no means comprehensive across Medicaid members. If primary care providers were actually reimbursed to screen each member for food insecurity, as well as other social determinants, and if additional dollars flowed from Medicaid or another sister state agency to reimburse the social service organization for meeting that need, we would have a systematic approach. Far fewer low-income Missourians would fall through the cracks, and I think we would start to see that meeting these social needs would actually improve health at the population level.”
Read the white paper: Recommendations for Missouri Medicaid Transformation, Paying for value & prioritizing the social determinants of health | December 2020
By Lauren Kempton, Abigail Barker, Leah Kemper, Timothy McBride, and Karen Joynt Maddox, Center for Health Economics and Policy at the Institute for Public Health, Washington University in St. Louis
The Center for Health Economics and Policy at the Institute for Public Health encourages the development of evidence-based research focused on improving health and disseminates this work to policymakers and other stakeholders.