LeadingAge New York Adviser Adviser LeadingAge NewYork Spring 2019 final | Page 24

Experts Discuss Efforts to Address Social
Determinants of Health for Older Adults
State and federal policymakers are pushing providers and managed care plans to address Social Determinants of
Health (SDH) as an integral component of care delivery, according to experts who spoke at the LeadingAge New York
Annual Conference. SDH are the socioeconomic factors and attributes of the physical and social environment that
influence an individual’s health status. Providers of non-medical senior services and supports can address these
social determinants and improve health outcomes, the speakers noted.
Elizabeth Misa, New York’s deputy Medicaid director, pointed out that while the United States spends a
higher percentage of its Gross Domestic Product (GDP) on health care than any other developed
country, it also spends the lowest percentage of its GDP on “social services spending” (e.g.,
spending on support services for older adults, disability and welfare benefits, employment
training and unemployment benefits, housing supports and other non-medical services.)
The New York State Medicaid program has been working with Managed Long Term
Care (MLTC) plans and providers of non-medical services to improve upon the
social and environmental factors that lead to poor health outcomes. The program
requires MLTC plans that are engaged in higher-level Value-Based Payment (VBP)
arrangements to implement SDH interventions and contract with a service provider
that does not bill Medicaid. Among the interventions highlighted were screening and
referral programs for SDH needs and peer-led health literacy programs. Although Ms. Misa
acknowledged that more State funding is needed for MLTC SDH interventions, she also noted that
the State is striving to increase cross-sector collaboration, improve SDH data collection and rethink
how “health care dollars” are spent on “repair” rather than prevention programs.
Nicole Fallon, vice president of health policy and integrated services at LeadingAge, described the various
initiatives at the federal level to focus additional resources on SDH. Specifically, she highlighted the recently
expanded scope of supplemental benefits that may be offered by Medicare Advantage plans. The benefits may
include assistance with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs),
transportation, home safety modifications, in-home safety checks, home-delivered meals and other non-
medical services. Providers of non-medical services can demonstrate their value to Medicare Advantage
plans by considering how their services could reduce hospitalizations or delay a long-stay nursing
home admission, their expertise in serving special populations and evidence of the effectiveness
of their services.
Demonstrating how a managed care plan can support SDH interventions, Mary Ellen
Connington, executive vice president, and Andrea Zaldivar, director of population
health at VillageCareMAX, spoke about their plan’s experience in developing
an intervention to prevent and address homelessness among its members. They
selected a community-based organization (CBO) partner, AIRnyc, based on the CBO’s
broad geographic coverage, expertise and sophistication. AIRnyc was able to negotiate a
complex contract, submit claims and transmit clinical data. AIRnyc will receive a monthly fee
and a bonus for every member who remains domiciled at the end of the year.
Connecting the dots among health care, behavioral health services and social services is critical
to positive health outcomes, according to Annie Wells, director of healthcare initiatives at Lifespan of
Greater Rochester. Lifespan’s Community Care Connections program provides social work care navigation
and nurse health care coordination for at-risk older adults. According to an independent analysis, the program
has resulted in a 36 percent reduction in hospitalizations and a 38 percent reduction in emergency room visits.
Efforts to address SDH are gaining traction, both among state and federal policymakers and in the field. According to
all of the speakers, the keys to success include digital communication among care partners, strong data collection and
analytics capacity and close contact with clients. By addressing SDH, plans and providers can improve the quality of life
of older adults while achieving better health outcomes and reducing the overall cost of care.
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Adviser a publication of LeadingAge New York | Spring 2019