Examining the factors constraining Medicaid managed care organizations’ efforts to address social determinants of health (SDOH)

Presenters/Authors

Samuel T. Opoku, Georgia Southern University, Jiann-Ping Hsu College of Public HealthFollow
Charles Owens, Georgia Southern University, Jiann-Ping Hsu College of Public HealthFollow
Linda Kimsey, Georgia Southern University, Jiann-Ping Hsu College of Public HealthFollow
Bettye Apenteng, Georgia Southern University, Jiann-Ping Hsu College of Public HealthFollow
Angela H. Peden, Georgia Southern University, Jiann-Ping Hsu College of Public HealthFollow

Document Type

Presentation

Presentation Date

10-25-2021

Abstract or Description

Background

The Medicaid population is a socially vulnerable population, with significant social and economic needs. Efforts to address medical needs of this population are often futile without consideration of social needs. Medicaid Managed Care Organizations (MMCOs) are increasingly taking a leadership role in the integration of social and health services. This study describes constraints to MMCOs’ efforts to address the social needs of Medicaid beneficiaries.

Objectives

1. Describe the challenges experienced by MMCOs in their efforts to address the social needs of Medicaid beneficiaries.
2. Describe how MMCOs have navigated challenges arising from efforts to address the social needs of Medicaid beneficiaries.

Methods

This was a qualitative study using data obtained from interviews conducted with 26 representatives of eight national and regional MMCOs. Participants included plan senior executives, medical directors, directors of case management, directors of legal and regulatory affairs departments and directors and staff of dedicated programs to address social needs of members. Interviews were audio-recorded and transcribed, and transcripts analyzed using thematic analysis.

Results

Participants reported challenges in the process of engaging stakeholders and delivery systems in efforts to address SDOH. Challenges were classified under the following emerging themes: (a) member engagement and retention challenges; (b) resource and capacity limitations; (c) challenges associated with developing and sustaining community-based partnerships; (d) data-related challenges; (e) prevailing paradigms for healthcare delivery; (f) silo mentality and lack of collaboration among stakeholders; and (f) difficulties in demonstrating the impact of SDOH investments. Participants described strategies for navigating each of these challenges, including relationship and coalition building, stakeholder education and advocacy, and strategic prioritization of resources.

Conclusion

The findings from this study suggest the presence of several constraints to MMCOs’ ability to effectively address the social needs of Medicaid beneficiaries. Efforts to mitigate these challenges are needed for MMCOs to deliver “whole-person” care effectively and efficiently

Additional Information

Georgia Southern University faculty members, Samuel Opoku, Charles Owens, Linda Kimsey, Bettye Apenteng, and Angela Peden co-presented Examining the factors constraining Medicaid managed care organizations’ efforts to address social determinants of health (SDOH) in the American Public Health Association (APHA) Annual Conference, October 2021.

Sponsorship/Conference/Institution

American Public Health Association (APHA) Annual Conference

Recommended Citation

Opoku, Samuel T., Charles Owens, Linda Kimsey, Bettye Apenteng, Angela H. Peden. 2021. "Examining the factors constraining Medicaid managed care organizations’ efforts to address social determinants of health (SDOH)." Department of Health Policy and Community Health Faculty Presentations. Presentation 329.
https://digitalcommons.georgiasouthern.edu/hpmb-facpres/329