Clinical interventions addressing nonmedical health determinants in Medicaid managed care

Abstract

Objectives: We aimed to examine how interventions addressing social determinants of health (SDH) have been adopted in the context of Medicaid managed care organizations (MMCOs), which serve a large proportion of patients with social and economic barriers to good health.

Study design: We designed a systematic literature review to examine how SDH interventions have been adopted in MMCOs.

Methods: The review included published articles from PubMed, Scopus, and Business Source databases, as well as review articles published in the gray literature and articles recommended by the study's National Advisory Committee to identify interventions describing how MMCOs have invested in interventions that address patients' SDH. To be included in the review, an article had to describe an intervention that was based in the United States, be supported financially by an MMCO, focus on at least 1 SDH, and be integrated into clinical care delivery.

Results: Twenty-five programs were identified in either commercial Medicaid or Medicaid-only MCOs that involved interventions integrated into clinical care and related to SDH. Interventions varied widely in terms of target populations and target SDH, and rarely included rigorous evaluations. The majority of programs described "case management services" that did not clearly distinguish between the delivery of medical and social interventions.

Conclusions: Despite a growing interest in clinical interventions that address SDH, little information is available in the published literature about the extent to which these interventions have been adopted by MMCOs, where they are likely to have early traction based both on capitated funding structures and the low-income populations served.