This issue brief is designed as a resource for states looking to adopt a measure to assess social risk factor screening rates. It is the result of a series of convenings that the authors facilitated with three states—Massachusetts, Oregon, and Rhode Island—which helped them consider, discuss, and share perspectives related to the development of their own social risk factor screening process measures. The issue brief looks at the progress these states and North Carolina have made in developing their own social risk factor screening measures and highlights considerations for other states either planning to adopt an existing or develop a new screening measure.
The past two years have seen a sharp increase in state Medicaid program interest in how social determinants of health (SDOH) influence Medicaid enrollee health status and spending. This brief provides an introduction to the first step most states are taking in response through their Medicaid managed care programs—screening members for social risk factors (SRFs). It explains why Medicaid managed care members should be screened for SRFs, identifies screening design decisions, identifies common SRFs, and reviews options for screening tool selection.
In October 2020, State Health & Value Strategies hosted a three-hour virtual roundtable with a select group of states.
In March, 2021, we held a second round of meetings with this roundtable group. Access to the meeting materials is restricted to the states that participated in the convening and available through this password protected page.
Coronavirus (COVID-19) Unwinding Federal Medicaid Flexibilities: Issues and Considerations for States
States quickly mobilized to implement emergency federal authorities (e.g., Section 1135 waivers, 1915(c) Waiver Appendix K, emergency Section 1115 waivers) and state-level regulatory flexibilities to respond to the COVID-19 pandemic; now they must determine which flexibilities to scale back or sustain, taking into account fiscal implications. The interaction of the stimulus package dates, the Public Health Emergency, and the President’s National Emergency Declaration, among other factors, are complex, and states are actively grappling with decision making regarding which flexibilities they need and want to keep, and how. This Excel workbook is intended to serve as a tool for states as they strategize and plan for the next phase of the COVID-19 pandemic. Specifically, states can utilize this template to conduct both a primary analysis as they determine which flexibilities to unwind or maintain and a secondary analysis to plan for operational and implementation implications. The workbook has been updated to reflect the renewal of the Public Health Emergency as of October 2, 2020.
On Monday, September 28, State Health and Value Strategies hosted a webinar on the Buying Value suite of resources to support state use of performance measures as they assess and improve value with managed care plans and accountable provider entities. Buying Value consists of two free Excel-based tools. The Buying Value Measure Selection Tool assists states, employers, consumer organizations and providers in creating and maintaining aligned quality measure sets. The Buying Value Benchmark Repository is a database of non-HEDIS measures in use by state purchasers and regional health improvement collaboratives, and associated performance data for benchmarking purposes.
On Thursday, September 17, State Health and Value Strategies hosted a webinar that will discuss the federal government’s response to the financial challenges facing providers. The COVID-19 pandemic has caused dramatic changes in utilization that threaten the financial stability of providers. Most of the Provider Relief Fund has been distributed, yet providers are still experiencing lost revenue and increased costs related to COVID-19. Medicaid payment strategies—especially for providers serving high numbers of Medicaid patients—remain a critical tool for states to support providers as new COVID-19 hotspots emerge and utilization patterns change. During the webinar, experts from Manatt Health reviewed examples of specific strategies states implemented between April and August 2020 to increase payments to providers in financial distress as a result of decreased health care utilization.
The COVID-19 pandemic has caused dramatic changes in utilization that threaten the financial stability of providers and may jeopardize access to care during and after the national emergency. With elective cases generally cancelled, hospitals have sharply lower utilization and revenue. Between March and August 2020, a combination of lost revenue related to fewer elective procedures and emergency department/outpatient encounters, and higher costs related to COVID-19 has put many hospitals in a precarious financial position. In addition, many other providers that rely on face-to-face visits have seen large utilization declines due to social distancing requirements: as of July 2020, outpatient visits remain 10 percent below the pre-COVID-19 baseline, even after accounting for the increased use of telemedicine. Most of the Provider Relief Fund dollars have been distributed, yet providers are still experiencing lost revenue and increased costs related to COVID-19. Under any scenario, Medicaid payment strategies—especially for providers serving high numbers of Medicaid patients—remain a critical tool for states to support providers as new COVID-19 hotspots emerge and utilization patterns change.
As the COVID-19 pandemic accelerated in April, State Health and Value Strategies hosted a webinar to discuss tools in both fee-for-service and Medicaid managed care that states can use to increase payments to providers in financial distress as a result of decreased health care utilization. Since that time, the federal government has responded to the financial challenges facing providers due to the pandemic in several different ways. The slide deck from the webinar has been updated as of August 26, 2020 to reflect more recent federal guidance and examples of specific strategies states implemented between April and August 2020.
This issue brief examines examples from two state Medicaid programs and one nonprofit quality measurement and reporting organization of the data sources they use to identify patients’ social risk factors when risk-adjusting payments or quality measure performance. Within the brief, we will examine both their approaches to risk adjustment based on social risk factors and how each entity filled their gaps in data on social risk factors. To inform this issue brief, the author reviewed publicly available documentation and articles on the three profiled examples of risk adjustment based on social risk factors.
On Wednesday, July 22, State Health and Value Strategies hosted part II of the Preparing for OEP 2021 webinar series that provided a deep dive into effective strategies to consider as states design their outreach and education campaigns for OEP 2021 in a shifting health care environment. Presenters from GMMB explored how the impacts of COVID-19 should inform the marketplace’s tactical campaign approaches for virtual outreach and partnership engagement, digital and social platform usage, and paid advertising and earned media. Participants also heard insights from several state officials from state-based marketplaces along the way. Topics for discussion included coordinating with state agencies, engaging micro-influencers, leveraging social media live streams, hosting virtual enrollment events, developing advertising buys, and considering new earned media hooks. This webinar included a question and answer session during which webinar participants can pose their questions to the experts on the line.