Oregon Medicaid Advisory Committee report focuses on social determinants of health

Last month, the Oregon Medicaid Advisory Committee released a report on how to address the social determinants of health (SDOH) in the Coordinated Care Organizations (CCO) model.

“When the coordinated care model was first established, stakeholders were excited about the potential for health plans to invest back into the community to address the social factors that impact an individual’s health,” said Jeremiah Rigsby, co-chair of the Medicaid Advisory Committee. “Providing managed Medicaid plans with the flexibility to make these types of investments was both transformative and instructive. Transformative because Oregon took the first steps in moving the managed Medicaid system into Social Determinants of Health work within the first 1115 Demonstration Waiver. Instructive because Oregon ended up with 16 CCOs, resulting in 16 different perspectives on which social determinants are important, and 16 different strategies for investing in these interventions.

The MAC report is important because it acknowledges the need for CCOs to be community based and to develop community based strategies to address social determinants, but it also adds meat to the bones of the original 1115 Demonstration proposal. The MAC gathered research from national and local stakeholders about social determinants, and conducted statewide surveys to identify how CCOs are currently investing in the community.  The MAC used this input to build the major pieces of this report:  standard definitions for both the Social Determinants of Health and Social Determinants of Equity, and recommendations to CCOs and the Oregon Health Authority on how to continue and improve intervention efforts within the Oregon Health Plan. We are just beginning to process what we have learned in the first five years of the coordinated care model. This report uses what we have learned over the last five years to build a foundation for what we want to accomplish next.”

The committee had five general recommendations to guide CCO efforts to address social determinants of heath.

  1. CCOs address SDOH with the primary purpose of improving health equity.
  2. CCOs support, leverage, and augment existing internal (CCO), community, and provider efforts and capacities to address SDOH, in order to increase the effectiveness of these efforts.
  3. CCOs build from their roles as the main Medicaid payer in a community, and use the unique tools provided by the CCO model to spend funds on SDOH.
  4. CCOs support health care teams and community partners in working together and with patients to identify and address the SDOH challenges patients face and would like help to resolve.
  5. CCOs address SDOH in a way that promotes person- and family-centered care, including tailoring SDOH efforts around member needs and desires.

The committee identified potential risks as CCOs work to address the social determinants of health. This include ignoring infrastructure needs, over- or under-medicalization, duplication, lack of research or community engagement, and lack of sustained investment. The committee stressed the importance of not adopting a one-size-fits-all approach and the need for clear communication around the work.

The committee identified ten roles that the CCO can take on in collaboration with community partners. A CCOs foundational role would be creating internal and infrastructure changes to ensure the organization and provider networks have the competency to address the social determinates.

The other nine roles are:

  • Creating direct investment opportunities through grants or more permanent funding
  • Funding health-related services that are not covered under the state health plan
  • Using value-based payments to incentivize providers to address social determinants of health
  • Contracting with community health workers
  • Aligning CCO priorities with community-selected goals or strategies
  • Bringing together diverse, multi-sectoral partners to identify common priorities
  • Providing health care data or data resources to partners
  • Compiling and distributing social needs and resource data to providers and other partners
  • Advocating for policies that address social determinants in communities

In addition to providing recommendations to the CCOs that will be selected during the 2019 procurement, the committee provided recommendations to the Oregon Health Authority. These included:

  • Increase tracking of CCO SDOH initiatives and policies, spending, and outcomes data, and share information publicly to identify best practices and areas for improvement. From increased tracking and data, establish clear goals and metrics to assess CCO spending and work on SDOH and equity.
  • Increase expectations for CCOs to assess health inequities and establish infrastructure and systems to improve health equity.
  • Ensure CCOs are using the unique tools provided by the CCO model to spend on SDOH, including health-related services, as well as investing additional savings and profits back into the community to impact SDOH.
  • Strengthen requirements for Community Health Assessments (CHA) and Community Health Improvement Plans (CHP), to ensure CCOs work with appropriate community partners and include SDOH and equity strategies in their CHAs and CHPs.
  • Establish clear expectations that CCOs have the connections and relationships in the community necessary to advance community-driven work in SDOH (e.g. community-based organizations, social service organizations, public health, etc.).
  • Provide SDOH learning and information sharing opportunities for CCOs to promote replication and scaling up of SDOH efforts.

CCO 2.0 contract is scheduled to begin in 2020. OHA Director Pat Allen provided some insight into the upcoming procurement in this recent podcast.