MCOs Team Up with CBOs To Address SDOH

By Lauren Flynn Kelly

Medicaid plans around the country have formed innovative relationships with community-based organizations (CBOs) to address social determinants of health (SDOH) such as housing instability and food insecurity.

Starting small with a local partner, putting some metrics in place to track the outcomes and then scaling a program up to serve more people in the community is a series of steps AmeriHealth Caritas District of Columbia has taken to address social determinants, said Keith Maccannon, the insurer's director of marketing, community relations and outreach, who spoke on an SDOH-focused panel at the 12th Annual Managed Medicaid Summit.

But being subject to evaluation early on in a partnership may be difficult for some smaller "mom and pop" organizations, weighed in Erica Lindquist, senior director of business acumen with the National Association of States United for Aging and Disabilities.

Another challenge that MCOs and their CBO partners sometimes face is around claims submission and reimbursement. Maccannon said AmeriHealth frequently uses administrative dollars to pay for services when it sees the business case for it, but that "encounter submission [by the community partner] is quite often one of the barriers to scalability."

Adam Zolotor, M.D., president and CEO of the North Carolina Institute of Medicine, said the state has formed a task force that is thinking about ways health systems and CBOs can partner to address SDOH under North Carolina's upcoming transformation to managed Medicaid. The state is trying to determine the various services to address SDOH that will be reimbursable and the rates to the CBOs that will offer those services, he adds.

From RADAR on Medicare Advantage