Texas HHSC releases action plan on non-medical drivers of health to address housing, transportation, and food insecurity


Boram Kim


The Texas Health and Human Services Commission (HHSC) released its action plan on non-medical drivers of health (NMDOH) at the Value-Based Payment and Quality Improvement Advisory Committee meeting on Feb. 21st.


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NMDOH, also referred to as social determinants of health, are conditions where people “live, learn, work, and play that affect a wide range of health risks and outcomes.” HHSC emphasized that addressing NMDOH falls within its priorities for adopting a statewide alternative payment model (APM). 

The plan places food insecurity, housing, and transportation as HHSC’s top NMDOH priorities for Medicaid and CHIP services, exploring cost savings from improved population health management and reduced healthcare utilization.

The plan outlines four central goals: build data infrastructure, coordinate services, develop policies and programs, and foster collaboration around NMDOH by FY 2025. 

HHSC will develop recommendations on measurables as well as requirements or incentives for managed care organizations (MCOs) to build into their NMDOH programs, such as performance improvement projects, recommended value-based payment models, pay-for-quality metrics, quality improvement costs, and in-lieu-of services.

HHSC said that once the infrastructure of screening and following up with members is in place, it would work to facilitate strategic partnerships between MCOs, providers, and community-based organizations to coordinate service delivery that meet the food, housing, and transportation needs of Medicaid and CHIP members.

“The first section [of the service coordination goal] is about identifying and facilitating strategic partnerships and a systematic approach with our partners—our MCOs, our providers, and our community-based organizations—to coordinate those service delivery models that most of them already working in some fashion but really wanting to coordinate that and be more systematic about it,” said Joelle Jung, senior policy advisor at HHSC. “[Coordinating referrals] as well when those needs are identified is a big system level action.”

The work outlined by Jung includes advancing options that impact identified food insecurity among Medicaid beneficiaries through existing programs like SNAP and WIC (the Special Supplemental Nutrition Program for Women, Infants, and Children). 

In alignment with the goals of the plan, Episcopal Health Foundation (EHF), a community-based philanthropic organization focused on improving community health, has already been fostering collaboration among providers and community-based groups in these services across parts of Texas. 

Dr. Ann Barnes, EHF’s president and CEO, led a presentation on the foundation’s work around NMDOH before the committee and outlined its commitment to HHSC’s action plan.

“We are in the very beginnings of looking for opportunities to invest in unique ways and in unique innovative strategies to see how that might assist us, along with grants, research, and community engagement, in moving the conversation and improving the health across the diocese,” Barnes said.

“[Our strategic plan has] a variety of goals but as it relates to the work of this committee, and the work of HHSC around non-medical drivers of health, you will see that we had a focus on strengthening systems of health. And one of those strategies was in the support of a change in healthcare financing and really looking at upstream factors that influence health.”

EHF has been involved with funding a variety of clinic and nonprofit projects that address NMDOH and have shown significant health improvements for Texas patients. EHF said it would continue working with HHSC on NMDOH projects and following the commission’s lead on the APM framework. 

EHF submitted a report in December that was part of the committee’s legislative recommendations this session to expand “upstream” Medicaid programs to cover NMDOH. The report shows the cost savings and health improvements associated when health insurance programs address non-medical factors that impact health.