Leveraging Medicaid to Address Social Determinants and Improve Child and Population Health

February 28, 2018 Tricia Brooks, Kelly Whitener

Top Lines

Addressing social determinants of health could play a role in reducing costs, while improving health and decreasing health disparities.

In This Report:

Key Findings

Our nation continues to struggle to reduce the cost of health care, or at least slow its growth. It is now widely recognized that addressing the social determinants of health could play a pivotal role in reducing costs while also improving health and decreasing health disparities.
As the nation’s primary insurer for the lowest- income and most vulnerable populations who are disproportionately impacted by social, economic, and environmental conditions, Medicaid has a key leadership role to play to broaden the scope of health care beyond clinical care.
Innovative efforts are emerging through improved coordination between the health care sector and community-based social service organizations and through payment and delivery system reforms.
If these approaches are focused on short-term cost savings, children may be overlooked because they are generally healthy and account for the lowest per-capita spending on health care. Impacting children’s trajectory in life will require early intervention and long-term investments to promote school readiness, academic achievement, and economic success as adults.

Introduction

For decades, health experts have recognized the decisive influence of social and environmental factors on people’s health, especially among poor and disadvantaged populations. Visual models showing that medical care has less of an impact on health outcomes than social and environmental factors have been circulating for years. Public health experts find this to be no surprise. From the early days of water sanitation and waste disposal to more modern public health interventions such as water fluoridation, public health experts have known that environmental factors can have an outsized impact on individual health. In fact, social and economic factors may have the largest influence on health.¹ However, efforts in the U.S. to address structural problems in health care systems by controlling health care expenditures and increasing efficiency have done little to tackle the social, economic, and environmental factors that influence health to a much greater degree than medical care.

Addressing the social determinants of health (SDOH) has long been a priority for global, national, state, and local public health efforts. But until recently much of the health care delivery system in the U.S. has focused almost exclusively on its role of providing clinical care to individuals. The U.S. spends $3.3 trillion dollars on health care annually² —more than 2.5 times more than any other country. But with studies showing that the impact of medical care on health may be as low as 10 percent, the health care sector is beginning to embrace a new reality— reducing health care costs and improving health outcomes necessitates addressing the root of the problem: SDOH. There is a growing interest among policy experts and health care leaders to explore opportunities to address the social determinants. Recently, Politico reported that a February 2018 Health Affairs summit on health spending included, “much glumness about all the rainbows and unicorns that have been chased and proved illusory . . . but the topic that got the overflow crowd jazzed…was spending on social determinants of health.”³

What better place to innovate than in Medicaid? After all, it is the single largest health insurer in the U.S. serving more than 74 million people,⁴ including the lowest-income and most vulnerable children and families whose health is more likely to be impacted by economic, social, and environmental conditions.

This brief is intended to ground health care advocates on SDOH basics and describe ways Medicaid, in partnership with the health plans and providers that deliver public coverage benefits, can improve the health of enrollees by addressing the SDOH. It provides background and highlights resources that can support advocacy efforts to drive change in how our public coverage programs evolve in order to achieve better health outcomes and reduce health disparities for low-income children and families.

What are the social determinants of health?

Social determinants of health are most often defined as the conditions in which people are born, grow, live, work, and age. These circumstances are shaped by the distribution of money, power, and resources: complex issues that need to be addressed at multiple levels.⁵ Importantly, SDOH are largely responsible for health disparities and inequities.

Affordable housing, economic security, safe neighborhoods, and access to adequate and healthy foods are major factors that impact the health of low-income children and families every day. Medicaid could play an even bigger role in addressing these issues in today’s health policy landscape.

Full Report

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Minnesota Department of Health, “Advancing Health Equity in Minnesota: Report to the Legislature,” February 2014, available at http://www.health.state.mn.us/divs/chs/healthequity/ahe_leg_report_020414.pdf.
Centers for Medicare & Medicaid Services, National Health Expenditure Data, “NHE Fact Sheet,” available at https://www.cms.gov/research-statistics-data-and-systems/statistics-trendsand-reports/nationalhealthexpenddata/nhe-fact-sheet.html.
A. Cancryn, Politico Afternoon Pulse newsletter, February 1, 2018.
Medicaid and CHIP Enrollment Data, November 2017, available at https://www.medicaid.gov/medicaid/program-information/downloads/november-2017-enrollment-data.zip.
O. Solar and A. Irwin, World Health Organization, “A Conceptual Framework for Action on the Social Determinants of Health,” Social Determinants of Health Discussion Paper 2 (Policy and Practice), 2010, available at http://www.who.int/social_ determinants/corner/SDHDP2.pdf.