title: Understanding Medicaid Managed Care Investments in Members' Social Determinants of Health.
abstract: Despite widespread interest in addressing social determinants of health (SDH) as a means to improve health and to reduce health care spending, little information is available about how to develop, sustain, and scale nonmedical interventions in diverse payer environments, including Medicaid Managed Care. This study aimed to explore how Medicaid Managed Care Organization (MMCO) leaders interpret their roles and responsibilities around SDH, how they garner resources to develop and sustain interventions to address SDH, and how they perceive the influences of external organizations on related activities. Semistructured qualitative key informant interviews were conducted with a purposive sample of 26 Medicaid Managed Care corporate executives. Data were analyzed with an iterative coding, thematic development and interpretation process. MMCO leaders' interests and activities around interventions to address SDH are described, as well as their perceptions of existing and potential incentives and barriers to expanding these interventions. Despite significant experimentation and programmatic diversity of interventions addressing social determinants, MMCO leaders struggle with clinical integration, financing, and evaluation efforts that could promote sustainability. Though their efforts are nascent, MMCO leaders are investing in tackling social determinants to improve health and to decrease health care spending in managed care settings that serve low-income populations. Results highlight both opportunities and concerns about sustaining and scaling clinical interventions addressing SDH.
authors.affiliation: 1 Center for Health and Community, University of California , San Francisco (UCSF), San Francisco, California.|2 Department of Family and Community Medicine, University of California , San Francisco (UCSF), San Francisco, California.
authors.forename: Laura
authors.initials: L
authors.lastname: Gottlieb
authors.affiliation: 3 Department of Social and Behavioral Sciences, University of California , San Francisco (UCSF), San Francisco, California.
authors.forename: Sara
authors.initials: S
authors.lastname: Ackerman
authors.affiliation: 1 Center for Health and Community, University of California , San Francisco (UCSF), San Francisco, California.
authors.forename: Holly
authors.initials: H
authors.lastname: Wing
authors.affiliation: 4 Health Begins , Studio City, California.
authors.forename: Rishi
authors.initials: R
authors.lastname: Manchanda
mesh_terms: D006801:Humans; D008484:Medicaid / Q000191:economics / Q000458:organization & administration; D000075485:Population Health; D064890:Social Determinants of Health; D014481:United States
keywords: Medicaid managed care; health care; population health; social determinants of health