Every passing week seems to bring a new change in healthcare policy focused on the social determinants of health (SDOH). In the Era of SDOH Care, we can expect to see these developments continue to arise for the next few years. As we look to 2020 on the horizon, some of the changes we're seeing include new SDOH-focused job titles for executives and a federal focus on community information exchange. We're also seeing states such as California, Arizona, and Florida revamp their Medicaid programs to support SDOH care models.
At a federal level, there are three main SDOH care developments we at ACT.md are tracking:
Social Determinants Accelerator Act
Introduced into the US House of Representatives back in July 2019, the Social Determinants Accelerator Act is touted as the first piece of federal legislation specifically focused on address the social determinants of health. As such, it would provide state, local, and Tribal governments with technical assistance and planning grants to develop innovative and evidence-based approaches to boost the cost-effectiveness of current programs, coordinate services for Medicaid beneficiaries, and improve beneficiaries' health outcomes. The bill also convenes an inter-agency technical advisory council on the social determinants of health. Just last week, the bill was also introduced in the Senate, which is a key milestone in ensuring the passage of this landmark legislation.
In the United States, Medicaid is the largest funded social service for the medical and health care needs of low-income populations. A Medicaid waiver allows states to test and develop ways it delivers its own Medicaid-funded programs that differ from the standard federal program. As of December 4, there are 23 Medicaid waivers across 19 states pending approval by the Centers for Medicare & Medicaid Services (CMS). Many of these proposed waivers contain significant structural changes to the Medicaid delivery system in their respective states, including work requirements, behavioral healthcare redesign, and managed long-term services and supports programs.
Medicare Advantage Special Supplemental Benefits
Medicare Advantage (MA) gives people an alternative way of receiving their Medicare benefits. The program is expected to grow to around 45-55% of Medicare enrollees by 2025, according to healthcare consulting firm LEK. CMS gave MA plans a boost with a 2019 payment rule allowing more flexible benefits for social determinants of health and virtual services. Some of those plans were rolled out last year, with about 40% offering one of the new types of supplemental benefits.
What's next for your organization?
Ready to change the standard of care coordination? To find out more about how organizations can take a leadership role in SDOH care, click below to watch a recording of our recent webinar, Winning in the Era of SDOH Care.