Medicaid leaders across the country are aligning around a common vision of a more person-centered Medicaid program that addresses social drivers of health (SDoH), improves coordination of care, and invests in health-related social needs (HRSN). To make this vision a reality, states need new tools and technology to facilitate collaboration, to measure person-level outcomes and system impact, and to drive accountability across sectors and providers. Addressing HRSN and the broader SDoH also requires deep community engagement and cross-sector partnerships of the providers and community-based organizations (CBOs) that are committed to delivering whole-person care. 

 At Unite Us, we combine technology infrastructure with supported community infrastructure to break down silos across sectors and government programs. Through Unite Us’ interoperable referral platform—which uses an electronic master person index to empower cross-sector care teams and evaluate individuals’ longitudinal community care journeys—we create seamless system linkages and closed-loop workflows across historically fragmented systems of care. The common platform we provide supports a true “any door” system of social care, produces system-wide analytics to measure social needs and community capacity at scale, and helps government leaders strategically shift investments upstream to maximize health benefits and better manage government spending. 

Addressing HRSNs and SDoH through Medicaid Managed Care 

Medicaid programs across the country are updating quality measures, establishing new care management requirements, and testing innovative risk modeling to encourage a greater focus on SDoH amongst managed care plans. Shared end-to-end SDoH technology infrastructure can break down access and quality gaps between coverage options. It also standardizes approaches to program oversight by using common measurement, data, and systems to identify members’ needs, facilitate effective outreach, engage members in services, track member- and system-level outcomes, and facilitate investments in needed community-based services. 

Nationwide, Unite Us’ end-to-end SDoH data and technology suite provides a blueprint for plans and Medicaid programs to proactively leverage SDoH data and infrastructure to drive measurable health outcomes and return on investment. 

States Taking The Lead

1. Quality Measures: Through their recently approved 1115 waiver demonstration, Oregon Healthcare Authority (OHA) redesigned its quality incentive program to include a new health equity upstream metric, “Social Determinants of Health: Social Needs Screening and Referral,” which incentivizes managed care plans not only to measure but also address HRSNs. The evolution of quality improvement measures related to SDoH is also being driven by leading healthcare quality standard entities, such as the National Committee for Quality Assurance (NCQA). The Social Need Screening and Intervention (SNS-E) measures are included in NCQA’s 2023 updated Healthcare Effectiveness Data and Information Set (HEDIS) quality measure slate. With this newly established measure, health plans can be evaluated on their ability to screen and provide interventions for members with housing, food insecurity, and transportation needs.

2. Care Management Programs: In Mississippi, managed care plans will be required to implement comprehensive care management programs inclusive of SDoH screening, risk stratification, and trackable closed-loop referrals. These requirements underpin a program-wide commitment to advancing health equity that is financially incentivized through minimum investment requirements in SDoH, as well as Medical Loss Ratio (MLR) allowances for costs associated with closed-loop referral platforms.

3. Risk Modeling: Incorporating social needs data into quality and risk adjustment programs is another important trend that ensures adequate funding is allocated to manage members’ social care needs. MassHealth, the Massachusetts state Medicaid agency, developed its medical risk adjustment model for managed care organizations (MCOs) and accountable care organizations (ACOs) by incorporating data found to be associated with heightened SDoH needs. The updated model considers age, unstable housing, a “neighborhood stress” score, disability, serious mental illness, and substance use disorders.

Shifting Investments Upstream

Through Medicaid waivers and other reinvestment initiatives, state Medicaid programs are advancing new initiatives to address HRSNs by directly funding CBOs that traditionally have not been financed by healthcare. The implementation challenge that states now face is how to create streamlined billing and reporting infrastructure for social care providers without over-medicalizing the delivery of needed community-level services. 

Implementation efforts for these initiatives must include a plan for supporting and reimbursing CBOs that provide health-related social services to create adequate capacity. In many instances, CBOs’ existing systems and workflows do not generate service-level invoices, manage reimbursements, or track outcomes. This is particularly true for smaller CBOs, which are often best positioned to serve vulnerable populations. These smaller CBOs and the populations they serve are likely to be left behind if states and health plans don’t provide them with the tools and support they need to participate. As Medicaid programs increasingly adopt requirements for connecting members to community partners, they must also invest in the protocols and technology needed to strengthen CBO capacity, including those needed for rate setting, reimbursement, and reporting.

With Unite Us Payments, CBOs can streamline service tracking and billing for social care services provided. Medicaid agencies using Unite Us Payments can track the flow of CBO funding and pair reimbursement with outcomes data to better understand impact and return on investment. Unite Us also generates data and insights, like our Health Equity dashboard, to provide our partners with actionable information that they can use to target resources and interventions to address local priorities, such as health disparities and inequities in access to care. 

Opportunities for Cross-Sector, Interagency Partnerships 

As state Medicaid programs take the lead in promoting statewide coordinated care networks, local government and other agencies need coordinated care networks to address priority populations and advance specific policy objectives. In a mature network, Medicaid programs improve coordination across agencies to support multi-system members, including foster children, justice-involved individuals, people with substance use disorders, or children with special health care needs. Establishing reusable statewide SDoH infrastructure to advance community-level care coordination is core to Medicaid’s role as a safety net coverage option. Statewide plans to invest in SDoH technology as part of a state’s Medicaid Enterprise Systems strategy can include more than just the healthcare delivery system by engaging a cross-agency governance team to proactively set system-wide priorities and needs across multiple at-risk populations. 

Unite Us is the only SDoH technology vendor that has scaled statewide with government partners. We leverage a robust, cross-sector planning and community engagement methodology to ensure that government partners maximize state and federal investments through regular access to, and use of, key SDoH indicators collected through our robust structured outcome taxonomy and standard data visualizations. 

Learn more

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Confirming its long-term focus on advancing health equity, NCQA announces changes for Healthcare Effectiveness Data and Information Set (HEDIS) in measurement year 2023, including:

• Race/ethnicity stratification in eight additional HEDIS measures with integration to additional measures planned over the next several years
• Gender-affirming approaches to ensure HEDIS measures appropriately by acknowledging and affirming members’ gender identity
• New social needs screenings and interventions measure to encourage plans to assess and address members’ unmet food, housing, and transportation needs using prespecified instruments

Understanding Diverse Social Needs Through Risk Stratification

Measuring stratification by race, ethnicity, gender, as well as other social risk factors, is critical to understanding diverse social needs in the population and addressing disparities.

Looking beyond clinical encounters and claims data, health plans can uncover hidden risk and devise proactive, whole-person approaches.

It’s important to note that social and economic indicators such as Z-codes, surveys, and geographic-aggregated data can help but have limitations. On average, 11,000 people live in a single ZIP code. Incomplete information or broad categories can lead to assumptions on larger populations and do not facilitate understanding or action. More detailed and standardized data fields help:

• Generate greater trust in data collection efforts.
• Better capture critical information on hard-to-reach populations.
• Increase efficiency and leverage meaningful and actionable data.

Unite Us’ Social Needs System (SNS) analytics framework helps zero in on the impact of social drivers of health. For example, we have observed that highly socially underserved members represent 30 percent higher regression on mental and physical health (Health Outcomes Survey).

Measure stratification can help not only better assess how social marginalization impacts plan performance and quality outcomes, but also better drive targeted interventions, and measure and prove impact.

Closing the Loop on Care with Social Screenings and Interventions 

Social needs screenings and referral tools should be integrated into systems of record to create a seamless and intuitive experience for care teams and ultimately members.

Feedback from our users highlights the importance of integrating social care in their care management platform and workflows to achieve true community care coordination.

Data standards, pre-built forms, and collaborative workflows reduce errors and improve efficiency in working with the community while also improving the ability to measure impact and close the loop on care.

Health plans can now build on social needs measures, assessments, and referrals to make sure their investments are driving impact on quality outcomes in their population—turning this from an additional effort to the key to unlocking value.

By connecting members with a consistent, accountable community network and real-time, actionable metrics, health plans can monitor and optimize impact on outcomes such as:

• Decreased waiting time
• Percentage of needs resolved
• Co-occurring needs and service gaps that need attention

Dedicated reporting can offer a health equity lens to help ensure and monitor that all individuals are receiving equitable access to care.

HEDIS 2023 updates are part of a larger industry and policy trend to shift focus and funding to effective and preventive whole-person interventions. The business case of health equity interventions rests on the ability to connect these interventions to impact on outcomes, lowering costs while promoting access to care and long-term sustainability.

Explore our solutions to learn how Unite Us enables health plans to succeed in meeting these new requirements, advancing health equity, and increasing value.

The post Health Equity in HEDIS 2023: How to Prepare for Success appeared first on uniteus.com.

Improving maternal and child health outcomes is a top priority for decision-makers and community stakeholders across the country. However, we continue to have the highest maternal death rate of all developed countries, and we are the only industrialized nation with a rising rate. At Unite Us, we know we can do better. That’s why we are dedicated to advancing equity and improving maternal health outcomes for all pregnant people and new parents.

In a new issue brief, we discuss maternal health challenges and priorities in the U.S. You will learn:

• Contributing factors to maternal health inequities
• Key policy priorities to improve maternal health
• Data solutions that take a human-centered approach to identifying needs and improving outcomes

Watch the Webinar

The Role Community-Based Organizations Play in Improving Maternal Health Outcomes

Community-based organizations (CBOs) have long played a key role in addressing critical care gaps, advancing equity, and supporting the health of mothers and infants. Through their community-driven approaches and culturally competent models of care, CBOs are not only better equipped to address the unique challenges and unmet needs of mothers and infants across communities, but also provide access to wraparound services that go beyond traditional models of care. These services, which range anywhere from community-based doula programs to freestanding birth centers, demonstrate the importance of adopting a human-centered approach to identify needs and improve outcomes.

It is only by continuing to leverage evidence-based, novel interventions, that communities will be able to help meet mothers where they’re at, when they need help most.

Empowering Partners to Drive Change

At Unite Us, we work with community-based organizations, health systems, and government partners to ensure all women and infants, particularly those at risk of poor health outcomes, have a chance at a safe and healthy life.

We believe innovative and collaborative strategies should focus on removing barriers to accessing care, emphasizing preventative approaches and integrated community programs. Our shared, community-wide platform makes it easier for health, human, and social service providers to:

• Connect underserved pregnant people and new parents to coordinated care and resources, so they can get the care they need when they need it.
• Leverage proactive interventions such as home-visitation programs, prenatal care providers, and breastfeeding support.
• Increase access to high-quality maternal care by partnering with credible provider networks and social service agencies; building strong partnerships and learning collaboratives with public and private stakeholders help advance equitable maternal health care in the U.S.

Partner Spotlight: A Model of Coordinated Care Powered by Unite Us

We’re proud to partner with organizations like First 1,000 Days Sarasota, which connects families with community resources such as financial assistance, healthcare, and food during pregnancy and in the first 1,000 days of life.

Care coordination: Sixty-five organizations and over 110 unique programs have joined Unite Florida in Sarasota County, connecting CBOs, pediatricians, obstetricians, and local government agencies to provide care coordination to low-income families and their children.

Parent participation: A parent advisory committee ensures parents’ voices are woven into every aspect of the initiative. The group meets every other month and offers guidance on their social media campaign, community murals, and initiative marketing strategies.

Targeted interventions: First 1,000 Days Sarasota formed a county-wide Plan of Safe Care task force. The Plan of Safe Care is a federal mandate to identify and support pregnant women with a history of substance use by providing ongoing care coordination for the families after birth until the child is five years old. Sarasota County is pioneering an innovative program by partnering with Unite Us to pilot their care coordination platform.

With critical policy tools, willing community partners, and the right SDoH solutions coming into place, we can turn this crisis around. No family should have to grieve during what should be one of the most celebratory times in life.

Download the brief to learn more about this partnership and how our data-powered, social care solution can drive change and positively impact maternal and infant health outcomes.

Interested in taking a collaborative approach to improving maternal health outcomes in your community? Watch our webinar to hear from industry experts on how adopting a collaborative approach is key when bridging gaps and driving better outcomes for new and expecting parents.

Watch the Webinar

The post Collaborative Innovations to Improve Maternal Health appeared first on uniteus.com.

While the wide-ranging effects of the COVID-19 pandemic are far from over, spending authorized through the federal government’s COVID Public Health Emergency (PHE) declarations may be ending soon. In the early stages of the pandemic, legislation offered states a significant bump in federal financing in exchange for suspending the usual eligibility redetermination processes. States refrained from terminating publicly sponsored health coverage for individuals who may have experienced changes in eligibility status during the pandemic. Since first established in 2020, PHE declarations have been extended for 90 days at a time; however, they are currently set to expire on April 16, 2022. Once the PHE expires, state Medicaid programs will be faced with the monumental task of reassessing Medicaid eligibility for millions of members within 12 months, creating significant planning and implementation burdens for already overextended state governments.

There are challenges in the Medicaid redetermination process. 

The objective of the Medicaid redetermination process is straightforward: to determine who remains eligible, re-enroll those members, and connect ineligible individuals with other potential sources of coverage. However, the execution of redetermination has created significant coverage churn historically. Prior to the pandemic, one in 10 Medicaid beneficiaries lost coverage and were subsequently re-enrolled within a year, likely due to a difficult-to-navigate re-enrollment system, use of old addresses for official redetermination notifications, and actual changes in eligibility, among other factors. These issues have been exacerbated by two years of the COVID-19 pandemic, during which, many vulnerable enrollees may have moved and their eligibility may have changed. These complex challenges will require thoughtful, proactive measures to ensure a successful redetermination process that re-enrolls eligible Medicaid members and directs ineligible individuals to alternative sources of insurance and care.

Targeted outreach efforts will help states assist those most vulnerable.

Medicaid members have diverse needs, communication preferences, and levels of engagement in their own care, which is why a one-size-fits-all outreach and engagement approach won’t work. Fortunately, thoughtful use of available data and robust communications planning can help Medicaid programs customize their outreach strategies in more feasible ways, even for very large memberships. Combining internal claims data with social care referral information and additional, publicly available datasets will help Medicaid programs make more informed decisions regarding potential Medicaid member eligibility and engagement strategies. Social determinants of health (SDoH) provide unique insight as to who is likely to remain eligible but may need additional assistance, as well as those who are no longer eligible for Medicaid but may qualify for subsidized coverage through the individual marketplace or Children’s Health Insurance Program (CHIP). State Medicaid programs can then target additional outreach to their most vulnerable members while connecting individuals with lower health and social risks who are no longer Medicaid eligible to alternative sources of healthcare coverage and support.

Unite Us is uniquely positioned to address challenges effectively.

A successful redetermination process does more than just ensure eligible members renew their Medicaid coverage and others are referred to alternative sources of coverage. It also provides an opportunity to proactively identify and address members’ total health and social care needs, which impact their health as well as educational, employment, and household outcomes. Unite Us is committed to enabling a successful redetermination process across the country, leveraging our end-to-end solution for social care. By partnering with state Medicaid programs and community-based organizations, we can successfully:

• Streamline and improve the Medicaid redetermination process while minimizing gaps in care.
• Help states establish effective risk identification and coordinated-care processes.
• Build an intuitive referral platform designed to better identify at-risk individuals and enroll them in high-impact interventions and services.
• Improve outreach strategies designed to address broader community health and social care needs.
• Continuously monitor and evaluate health and social risks, enabling improvements to the redetermination process during the critical, 12-month, post-PHE period.

Unite Us will help your members get the right care at the right time. To learn more about our end-to-end solution for social care, visit our solutions page.

The post Unite Us Offers Proactive Solutions to Help States Manage the End of Public Health Emergency (PHE) appeared first on uniteus.com.