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Issue Brief Summarizes Promising Efforts to Address Social Determinants of Health for Medicare and Medicaid Dual Enrollees

The issue brief provides case studies for demonstrations in Minnesota, South Carolina and Washington


RESEARCH TRIANGLE PARK, N.C. — A new issue brief by researchers at RTI International, a nonprofit research institute, offers a summary of promising efforts aimed at identifying and addressing social risk factors and social needs associated with social determinants of health (SDOH) for Medicare and Medicaid dual enrollees across the country, with a specific focus on demonstrations in Minnesota, South Carolina and Washington state.

The research team used qualitative findings from stakeholder interviews, beneficiary focus groups and other activities conducted from 2015 through 2018 under an evaluation sponsored by the Centers for Medicare & Medicaid Services (CMS) of its Financial Alignment Initiative (FAI), aimed at testing integrated care and financing models for Medicare-Medicaid enrollees in certain states. They also included supplemental information from beneficiary focus groups conducted by another CMS contractor.

“We encourage CMS, states, plans, providers, advocates, and stakeholders to use this issue brief as they consider ways to address social determinants of health and improve the beneficiary experience for dually eligible enrollees,” said Amy Chepaitis, Ph.D., a public health systems researcher at RTI and lead author of the issue brief.

The researchers found that while care coordination is a key mechanism across all FAI demonstrations, approaches taken to address the SDOH of enrollees vary. Locally available resources, contract requirements, plan processes and enrollee-specific circumstances and needs lead to different strategies, the issue brief says.

The researchers offer several action items for states attempting to address SDOH for dually eligible enrollees:

  • Focus on person-centered care.
  • Provide mechanisms for the flexible and creative provision of SDOH-related connections and services.
  • Include SDOH-related requirements in managed care plan, provider, and community partner contracts.
  • Educate enrollees about the availability of these supports.
  • Explore options for collecting and integrating SDOH data in health information technology (HIT) systems, such as patient portals, electronic health records, and health information exchanges.

View the full issue brief