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. 23 Adviser a publication of LeadingAge New York | Spring 2019