Description

This brief illustrates how states can use existing Medicaid authority to finance innovative upstream prevention and population health initiatives. In 2017, Nemours Children’s Health System contracted with the Center for Health Care Strategies (CHCS) to work with the PacificSource Columbia Gorge Coordinated Care Organization (CCO), a regional Medicaid payer operating as the sole managed care organization in a rural area in Oregon, to identify sustainable financing mechanisms for the Bridges to Health Pathways Hub, which provides community service referrals and care coordination to residents in the Columbia Gorge area. This brief draws upon the practical lessons learned through that work and provides advice for state Medicaid agencies and managed care organizations (MCOs) interested in implementing similar social determinants of health strategies within managed care, by reflecting upon: 1) what existing Medicaid Managed Care authorities can be used to cover community care coordination and service delivery activities related to social determinants?; 2) what incentives do managed care organizations have to invest in such programs?; and 3) What are innovative ways to pay for these services, in alignment with the broader shifts to value-based purchasing?