Stories from the Field: A Narrative Thematic Analysis of MCOs Efforts to Address Social Needs of Medicaid Enrollees

Document Type

Presentation

Presentation Date

6-16-2021

Abstract or Description

Research Objective: To understand the impact of Medicaid Managed Care Organizations’ (MMCOs) growing focus on social determinants of health (SDOH) on beneficiaries and community-based organization partnerships.

Study Design: Key personnel interviews with 26 representatives of MMCOs whose job either focuses on – or is directly related to – programs focused on SDOH were conducted. Interviewees represented eight MCOs across nine states. These interviews focused on the processes and relationships necessary for developing, managing, and sustaining SDOH programs. Participant narratives about their ongoing efforts to address SDOH were analyzed using a narrative thematic analysis.

Population Studied: Interviewees were representatives of MMCOs across the nation that are engaging in SDOH-focused initiatives.

Principal Findings: MMCOs are experimenting in a wide range of SDOH initiatives to improve beneficiary health outcomes.

Interviews with MMCO representatives revealed recurring stories of successes and challenges. These stories reflect the complex situations of beneficiaries, the typically small, grassroots, community-based organizations that serve them, the intra-organizational dynamics that SDOH departments face, and the interactions with state organizations that sometimes dictate their practices. Stories involving the homeless population and maternal and child health (MCH) were some of the most compelling – illustrating complexities and challenges at and between the beneficiary, community-based organization, MMCO, and state levels – and requiring unique consideration for helping beneficiaries with SDOH services for food, transportation, housing, etc.

  • HOUSING: The homeless population is challenging for MMCOs to manage. They are typically hard to contact, transient, and have little social support. MMCOs have begun partnering with shelters to identify whether - and with whom - patrons are insured. This allows MMCOs to enhance their knowledge of the services that beneficiaries receive and improves their ability to intervene to improve health. This knowledge also allows MMCOs to understand that simply providing housing is not the final solution: a well-supported network of services is essential.
  • MCH: Mothers-to-be, new mothers, and children are another complex population on which MMCOs are focusing their SDOH efforts. Stories of MCH-related initiatives involved providing car seats, parenting education, and nutrition support. Once again, these stories illustrate the importance of utilizing a well-supported network of services.

Conclusions: As interest in SDOH investment by MMCOs grows, beneficiary-focused stories of successful SDOH efforts can serve as useful guideposts for program design. Along with improvements in beneficiary health, the stories shared by interviewees reflect the complexities of SDOH program management and their efforts to navigate them.

Implications for Policy or Practice: Designing effective SDOH programs requires acknowledgement of their complex nature. Experiences and stories of MMCO SDOH early adopters can be informative for others striving to implement SDOH initiatives.

Additional Information

Georgia Southern University faculty members, Linda Kimsey, Charles Owens, Samuel Opoku, Bettye Apenteng, and Angela Peden co-presented Stories from the Field: A Narrative Thematic Analysis of MCOs Efforts to Address Social Needs of Medicaid Enrollees in the Academy Health Annual Meeting, June 2021.

Sponsorship/Conference/Institution

Academy Health Annual Meeting

Location

Virtual

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