Social determinants of well being (SDoH)—the circumstances by which individuals stay and the methods that form these circumstances—are more and more receiving consideration. The COVID-19 pandemic, by exacerbating inequities and highlighting the prevalence of unmet fundamental wants,
has accelerated efforts to deal with SDoH.
State Medicaid businesses, payers, suppliers, distributors, community-based organizations (CBOs), and different stakeholders have taken up the torch and are laying the foundations for long-term SDoH applications (see sidebar “What are social determinants of well being?”).
Regardless of the momentum, nonetheless, many stakeholders throughout the ecosystem are nonetheless within the early phases of addressing sufferers’ SDoH sustainably and at scale. Stakeholders largely cite funding as the most important barrier to actual progress.
Many stakeholders know of obtainable funding for delivering companies comparable to meals help, housing assist, and transportation. Nevertheless, choices for funding information, analytics, and expertise infrastructure that may optimize efforts to ship companies are much less well-known. However this funding does certainly exist. And it may be used to assist information integration (collating social-needs information alongside scientific and different information) and screening and referral capabilities (enterprise processes and capabilities that embody SDoH information units to drive enrollment into focused case administration profiles for sufferers’ threat profile).
In pursuing these applications and in search of to safe funding, coordination throughout stakeholders could also be essential. SDoH is minimize throughout a wide range of focus areas and could possibly be addressed higher by working throughout payers, suppliers, states, communities, and different native actors and businesses. SDoH distributors can work alongside states and different entities to determine these funding potentialities and unify disparate stakeholders to unlock monetary help, doubtlessly leading to evidence-based options throughout methods, scientific departments, and applications—and, finally, elevated influence (see sidebar “Federal funding alternatives for actors that handle social determinants of well being”).
This text describes 4 federal financing mechanisms which are accessible to assist SDoH information and analytics efforts and issues for accessing them. Whereas these insights primarily deal with potentialities for state Medicaid businesses, there are implications and potential alternatives for stakeholders throughout the ecosystem. This evaluation shouldn’t be exhaustive; moderately, it gives a useful place to begin for planning and forming partnerships to assist SDoH.
4 federal-funding channels can be found for SDoH infrastructure efforts
Stakeholders can think about 4 federal-funding channels to advance their SDoH targets: waivers and authorities, federal businesses and applications, rising alternatives ensuing from current laws, and managed-care requirements and assist. A few of these federal channels present ongoing assist, for instance, by means of a federal match or reimbursement technique, whereas others present one-time assist comparable to by means of grants (see sidebar “Definitions of funding phrases”). Native- or state-level and personal or philanthropic funding, whereas not evaluated on this article, could present further funding alternatives for stakeholders to contemplate.
1. Waivers and authorities
Though federal Medicaid funds are historically used to cowl the prices of medical companies, a wide range of waivers and authorities have added flexibility so these funds can cowl nonmedical companies outdoors of the Medicaid state plan—comparable to case administration, meals assist, and housing assist—that contribute to well being outcomes (Exhibit 1). This added flexibility may additionally cowl information and analytics infrastructure to assist enhance how SDoH companies are delivered and the outcomes of those companies on individuals’s lives.
The Facilities for Medicare & Medicaid Providers (CMS) articulated a variety of these waivers, authorities, and different helps accessible to deal with SDoH in a letter to state well being officers in 2021.
Extra lately, the Medicaid and CHIP Cost and Entry Fee (MACPAC) launched a problem transient on SDoH financing methods.
Exhibit 1
Whereas waivers and authorities primarily fund direct-service supply authorities, states usually have flexibility within the proposals they put forth by means of waivers—for instance, they might outline their very own demonstration undertaking or pilot for an 1115 waiver. However waivers additionally usually embody tips—comparable to demanding funds neutrality or {that a} undertaking demonstrates worth by way of high quality and price to the Medicaid program—to make sure consistency in desired outcomes.
Federal matches from Medicaid waivers and authorities, in addition to grants from the Facilities for Medicare & Medicaid Innovation Heart (CMMI), are among the many mostly used federal-funding sources for state Medicaid businesses to assist SDoH information and programming efforts thus far (see sidebar “How California and North Carolina have harnessed waivers to advance SDoH information and expertise infrastructure”).
2. Federal applications and businesses
Federal applications and businesses embody sources that frequently fund state Medicaid businesses and have supported SDoH and information and analytics infrastructure efforts, in addition to sources that assist SDoH efforts however aren’t generally identified for funding state Medicaid businesses (Exhibit 2).
Exhibit 2
Conventional state Medicaid assist. Conventional-funding sources that state Medicaid businesses can entry come from each the CMMI and the Medicaid Enterprise System (MES) by means of the Heart for Medicaid and CHIP Providers (CMCS). CMMI gives grants to check modified fee approaches and, at occasions, gives particular grants to assist SDoH initiatives. For instance, CMMI’s previous Accountable Well being Communities Mannequin grants linked Medicare and Medicaid beneficiaries to neighborhood companies with funding for screening social wants, referrals, and care navigation.
Further SDoH-related funding alternatives are prone to come up from CMMI on condition that it prioritizes well being fairness as a core strategic goal and addressing SDoH might help obtain this fairness.
CMCS MES approval, by comparability, is an ongoing funding supply to advance Medicaid infrastructure and expertise. CMCS MES funding is often utilized by states to construct broader information and infrastructure however has thus far been a largely untapped supply for SDoH information and infrastructure capability-building (see sidebar “An in-depth take a look at CMCS MES funding”).
Funding from different authorities applications and businesses. Different federal applications and businesses whose missions align with SDoH-related priorities, such because the Well being Sources and Providers Administration, Division of Housing and City Growth, and Division of Agriculture, amongst others, current further potential federal-funding sources. Stakeholders might be able to codevelop SDoH information and referral options by contemplating potential flexibility below block grants (that’s, grants from a federal to native authority, usually with flexibility to be used) or by means of partnerships with different organizations that generally obtain funding from these sources—comparable to cities, counties, native public-health departments, and not-for-profits.
Others have set the precedent of utilizing funding from these sources for SDoH-related technological assist. For instance, 211 San Diego is a not-for-profit group connecting people with neighborhood, well being, and catastrophe companies. With a mixture of company, basis, and authorities assets—together with US Division of Agriculture (USDA) assets supporting referral-related expertise—it has developed a cellular software that provides customers updates as they progress within the means of discovering neighborhood companies.
Different businesses, such because the CDC, have traditionally been much less conventional sources for state Medicaid assist however could current a better alternative going ahead. Certainly, the CDC is forecasting an funding of roughly $4 billion by means of grants for strengthening US public-health infrastructure, workforce, and information methods that could be open to entities comparable to state and native governments.
3. Current laws
Current legal guidelines such because the American Rescue Plan Act (ARPA) and the Bipartisan Infrastructure Regulation have elevated the federal funding accessible to assist SDoH-related efforts. This laws is offering direct meals and housing helps in addition to investments in information modernization and infrastructure. For instance, it was introduced that funding from ARPA would additionally assist the CDC’s public well being infrastructure, workforce, and information modernization efforts.
A lot of this funding might be seen by means of the federal applications and sources listed above, and SDoH stakeholders can look ahead to future grants and associated alternatives from these new assets. An instance of that is the inclusion of the Digital Fairness Act within the Bipartisan Infrastructure Regulation, which allocates $2.75 billion over 5 years to deal with, for instance, broadband infrastructure to enhance healthcare outcomes in underserved communities (Exhibit 3).
Exhibit 3
4. Managed-care requirements and assist
There may be potential to unlock funding for SDoH by means of requirements and helps associated to managed care (Exhibit 4). Managed care—a funding mannequin by means of which funds are per affected person moderately than per service, with various levels of monetary threat—shouldn’t be itself a federal funding mechanism. However states can entry federal assist by means of federal grant initiatives associated to managed care. For instance, CMS various fee mannequin innovation funding, comparable to previous State Innovation Mannequin (SIM) grants, are associated to managed care (see sidebar “How Michigan used SIM funding and MCO necessities to advance SDoH infrastructure”). The SIM initiative offered federal assist for states advancing multipayer healthcare fee and supply system reform fashions to attain higher high quality of care, enhance care outcomes, and ship decrease prices.
States could proceed to search for future CMMI grants targeted on advancing managed care and modern fee fashions to unlock SDoH information and potential infrastructure assist.
Exhibit 4
Stakeholders may also be aware of federal requirements that may have an effect on managed care, comparable to medical loss ratio (MLR) inclusion rules.
MLR is a monetary measurement outlined by CMS that appears to reveal and guarantee worth for beneficiaries. This worth is measured by high quality enchancment actions to enhance healthcare outcomes, together with wellness and SDoH.
Linking SDoH investments to high quality enchancment could assist states unlock further assist.
Past these federal helps, states have the flexibleness to encourage innovation in SDoH throughout managed-care organizations (MCOs). For instance, MCOs can use value-added companies and “in lieu of” companies to offer companies that will embody SDoH-related advantages; states may additionally use procurement, contracts, and efficiency administration throughout MCOs to encourage SDoH-related improvements.
Information gives perception into who has unmet fundamental wants, and a referral platform can enable people to be related to well timed interventions that enhance well being outcomes.
Potential actions to advance SDoH infrastructure efforts
Throughout funding mechanisms, states could think about eight actions to construct on the present momentum round and improve emphasis on well being fairness and SDoH to advance SDoH information and expertise infrastructure efforts and doubtlessly seize the total worth of obtainable funding channels.
Integrating SDoH into broader strategic priorities. To unlock federal assist for SDoH, states, distributors, payers, suppliers, and others are more and more highlighting that SDoH is integral to broader strategic priorities throughout organizations moderately than a one-off undertaking. For the Medicaid program, for instance, addressing SDoH could possibly be a part of the technique to enhance particular person and population-level outcomes and to decrease care supply prices.
Articulating how SDoH information and infrastructure is a important enabler. Along with integrating SDoH into broader strategic priorities, stakeholders could want to emphasize the significance of SDoH information, expertise, and infrastructure as an enabler to unlocking the worth from SDoH. For instance, information gives perception into who has unmet fundamental wants, and a referral platform can enable people to be related to well timed interventions that enhance well being outcomes. Emphasizing the position of SDoH information, expertise, and infrastructure in enabling these efforts could assist states and different stakeholders in accessing less-traditional funding mechanisms for this goal.
Bridging the hole between IT or information applications and service-delivery applications. To foster better coordination and influence, IT and repair supply departments may work in tandem, recognizing the worth SDoH information and expertise can have in accelerating and bettering service supply efforts.
Partnering and mixing funding mechanisms. Stakeholders could think about combining or sequencing funding mechanisms—from a number of federal sources in addition to state, native, non-public, and different sources—to doubtlessly unlock better resourcing and guarantee sustainability. For instance, if a state receives an 1115 waiver to advance SDoH information and expertise, it could additionally pursue CMCS MES funding to advance the trouble. To successfully streamline funding throughout companions, stakeholders could think about the right way to collaborate and work on joint efforts with a deliberate method to cooperative governance. This partnership or coalition-based method could unlock better entry to disparate funding mechanisms and guarantee better alignment throughout the SDoH ecosystem (Exhibit 5).
Increasing goal beneficiary populations. Stakeholders may additionally think about steps to broaden SDoH efforts to a wide range of beneficiary populations, comparable to pregnant girls and kids, as SDoH information and expertise allows a deeper understanding of wants and a better attain with efforts. For instance, closed-loop referrals can assist an unlimited array of sufferers. This may occasionally additionally assist states and different stakeholders in accessing less-traditional funding sources, comparable to from authorities businesses.
Evaluating governance and functionality gaps. Throughout funding sources, clear programming governance and a robust understanding of present state information and expertise capabilities and gaps could possibly be key to success in SDoH efforts.
Assessing approaches to implement SDoH infrastructure. Stakeholders could think about approaches comparable to Medicaid contracting, MCO necessities and MLR allowances, well being info trade (HIE) partnerships, and department-specific initiatives to implement SDoH expertise and infrastructure.
Contemplating how information is gathered and retained, stakeholders may additionally need to think about what sorts of information and information assortment and transmission requirements are required to assist SDoH within the context of interoperability. As conversations on interoperability proceed, stakeholders will doubtless want discussions on information possession, information methods of reality, and the way the information is utilized in a manner that optimizes and contextualizes care supply and outcomes that drives holistic influence for a person.
Stakeholders throughout the broader healthcare ecosystem can come collectively and construct on the momentum at present surrounding SDoH to doubtlessly unlock transformational influence for sufferers and communities whereas additionally contributing to improved healthcare and financial productiveness. Though quite a few federal-funding potentialities can be found in silos, a collaborative or partner-driven technique—by which human companies, Medicaid, and different stakeholders work collectively to make use of their related funding mechanisms to assist the wants of their shared beneficiaries—may doubtlessly increase the influence of SDoH efforts. This collaboration may encourage information sharing that will remodel stakeholders’ understanding of unmet fundamental wants, together with the right way to handle them.
Authorized disclaimer: These supplies don’t represent authorized, medical, coverage, or different regulated recommendation. The recipient stays solely accountable for all choices, use of those supplies, and compliance with relevant legal guidelines, guidelines, rules, and requirements.
