What AHIP's Latest Recommendation Means for SDoH


AHIP Latest Recommendation

The latest policy recommendations from America’s Health Insurance Plans (AHIP), the public health policy advocacy group, details critical actions we can take today to more effectively treat and manage the social determinants of health (SDoH). These are the five key takeaways from the in-depth report—along with all of the potential implications for SDoH.

1. Greater flexibility built into Medicaid waivers

Where states have the power to determine the scope of services covered under Medicaid waivers, and when non-medical services and interventions are included among them, it's a win-win. At Healthify, in fact, this is a topic we're passionate about and strongly endorse, and we've been closely tracking the state-by-state movement on Medicaid 1115 waivers for some time. From employment-related services to food, housing, transportation and more, there's so much more that can be done to help move the needle on SDoH.

After all, there's clear consensus on all sides that SDoH-related offerings can help drive down healthcare costs, hospital utilization and more. At the same time, more needs to be done to make that happen. Greater flexibility around Medicaid waivers could be an important catalyst for progress and change.

2. Greater coordination via joint waivers

We strongly believe that health is about way more than just "healthcare." That's a shared passion that unites all of us at Healthify, which is one of the reasons we're always pushing for holistic approaches to medicine that treat the whole person—as opposed to, say, costly and oftentimes ineffective one-off interventions. So we firmly stand with AHIP on this one. State Medicaid agencies should have the option to partner with other state agencies to take advantage of synergies and create robust, cost-effective solutions. But in order for that kind of thing to happen, there needs to be a viable pathway in place first.

Partnerships and joint waivers of this kind could be the impetus for meaningful positive change in how our healthcare system operates, and how different actors in it coordinate care. Besides, at this point, is there anyone who still thinks that silos are a sound idea?

3. Make SDoH initiatives part of medical loss ratios (MLR)

Along with new, more flexible funding models, AHIP is calling for all players in the healthcare ecosystem to rethink how SDoH is treated. After all, they impact 80 percent of a person's overall health. So while the kind of services that address SDoH may not be clinical in nature, they’re certainly healthcare-related, or at least healthcare-adjacent, and AHIP strongly recommends that the cost of these services be added to health plans’ medical loss ratios (MLR). 

This point may sound purely academic, but it’s actually anything but. In fact, its implications would be seismic for CBOs and other organizations that provide SDoH services. By being categorized as actual healthcare costs, health plans would be able to invest in critical social services that impact health outcomes. That’s a win for CBOs, the people they serve, and public health at large.

4.  More flexible "in lieu of services"

Medicaid MCOs can already deliver select services not normally covered by state plans if those services are both appropriate and come at a lower cost than a similar, but covered service. These so-called "in lieu of services” (ILOS), in which an alternative intervention is covered at a lower cost, aren't happening at the kind of frequency or scale required to disrupt the status quo.

Enhanced flexibility? A rapidly advancing body of best practices around combatting SDoH? Yes, and yes, please. These could be some of the positive externalities that such a change might bring with it. But flexibility is key.

5. GoFundMe for Medicaid MCO providers?

Well, not quite that exactly. But AHIP is advocating that Medicaid MCO providers should be able to leverage new pooled funding and shared resource arrangements — something that could have a major impact on our ability to make headway on SDoH. After all, many community-based organizations (CBOs) continue to confront challenges inhibiting their ability to drive greater impact or scale, and many of those challenges boil down to funding.

To be sure, any change that makes it easier to bring together disparate sources of funding would be welcome by those who are already in the best position to positively impact the communities they serve.

Key Takeaways

The latest recommendations from AHIP are at once far-reaching and actionable, practical and strategic, forward-thinking yet very much within the realm of what is possible today. In sum, we felt like they were spot on—and AHIP's recommendations certainly resonate with our mission at Healthify. So if you, too, share our passion, and you want to join us as we work to broadly change the way we think about and treat SDoH for good, contact us today.

Topics: Medicaid public health healthcare policy population health

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