25 Sep GAO Report: Need for Social Determinants of Health Programs to Treat High-Cost Medicaid Beneficiaries

The Government Accountability Office (GAO) recently issued a report about how Social Determinants of Health (SDOH) such as a lack of stable transportation or housing are making it difficult for states and managed care organizations to treat the most expensive Medicaid beneficiaries.

While the report found that many states used care management, which coordinates care across different providers, to rein in high-cost beneficiaries, many also reported major hurdles with implementing care management for some high-cost beneficiaries.

These hurdles included having valid patient contact information, lack of transportation to doctor appointments and inconsistent access to food and housing. As we highlighted before, many payers are taking steps to address these challenges.

For example, Blue Cross and Blue Shield of Illinois is investing $1 million in “housing and wraparound support services for members of Chicago’s homeless community to improve their health and reduce healthcare costs.” And, Optima Health is launching a new program that lowers financial barriers to healthy food options, and increases overall food security.

At the recent AHIP 2019 Expo, UPMC Health Plan also discussed special housing programs for homeless health plan members which have proven to lower per member per month (PMPM) healthcare costs.

While there has been progress, the GAO report found that state officials had problems measuring these SDOH outcomes, making the incentive program hard to administer.

Fortunately, the right data management solutions can help payers to better align claims and clinical systems to inform and drive new SDOH and population health initiatives, as well as help to measure the outcomes of these efforts.

Leveraging Natural Language Processing (NLP), IMAT customers have been able to identify SDOH indicators that already exist within their data to better identify those at risk. From Provider Dashboards to Business Intelligence tools to longitudinal patient charts, IMAT’s Health Data Analytic capabilities can transform population health and risk management for payers.

To learn more about how payers can best harness their data for improved analytics, interoperability and outcomes, please click here.