By Mandy Ferguson and Naomi Newman, JD Supra, October 25, 2021
Overview
Increasingly, states are using their Medicaid managed care (MMC) contracts to define the role Medicaid and Medicaid managed care plans can play in addressing unmet social needs and promote a “whole person” approach to care. A few leading states are leveraging contracts with Medicaid managed care organizations (MCOs) to require health plan investment into the community being served. This article describes the context for these requirements and sample approaches for state Medicaid agencies to integrate community investment strategies into MMC contracts.
Community Investments Are Critical Now, More Than Ever
There is a growing recognition that socioeconomic factors significantly affect health outcomes—research suggests that 80 percent of an individual’s health outcomes are attributable to nonmedical factors.1 Often referred to as “drivers of health,” these factors refer to “the structural conditions in which people are born, grow, live, work and age” that have profound implications for an individual’s overall well-being.2 Recognition of this reality is fueling new community investments and change in health care delivery systems.
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