Social Determinants of Health (SDoH) are defined as the conditions in which people are born, live, grow, work, and age. These conditions can affect a wide range of health risks and outcomes.
The six key domains of SDoH include:
- Economic stability
- Neighborhood and built environment
- Education
- Nutrition
- Social and community context
- Health and health care
Integrating health and human services to address SDoH can have a significant impact on health outcomes. Under Value Based Payment (VBP), Healthcare systems and Medicaid health insurance companies aim to realize savings while achieving quality outcomes by addressing SDoH conditions that drive high healthcare cost and poor health outcomes.
New York State has already approved several SDoH Interventions for VBP for New Yorkers enrolled in the Medicaid health insurance program. The Bureau of Social Determinants of Health keeps a list on their website.
How can my agency get a contract to provide services for people with Medicaid?
New York State policy encourages insurance companies that cover Medicaid recipients to contract with Community Based Organizations (CBOs). If your agency wants to participate, answer the following questions:
1. Does one or more of your services reduce healthcare costs?
Examples of healthcare cost reduction outcomes include:
- Reduce preventable Emergency Department visits
- Improve medication adherence for people with chronic conditions
- Prevent domestic violence and child abuse
- Foster healthier lifestyles (quit smoking, lose weight, increase exercise)
- Enhance mental health
- Provide housing
- Address food insecurity, hunger and "food deserts"
- Avoid re-hospitalization
If you answered "no" to Question One, a Medicaid-related contract is probably not in your future.
2. If you answered "yes" to Question One, what is your evidence?
Many CBOs lack the kind of careful data collection needed to "prove" to a healthcare system or insurance company that the work you are doing really impacts the healthcare cost reduction outcomes above. Without "evidence" your organization is unlikely to get a contract.
SWB Consulting Services can help you identify SDoH Interventions you are already providing and reframe them to be payable by health insurance companies. Contact us to learn more.
