Post From Expert Insights
As we enter 2023, I am excited about this new phrase/concept I learned at several policy conferences I attended in D.C. this November. The phrase “whole-of-government” was cited by a variety of federal departments, legislators, and advocacy groups. By the end of the month, it had become part of my vocabulary to describe the accumulation of initiatives I have been talking about for over twenty years – building inter-agency collaboration, blending and braiding social program funds, and improving approaches to poverty.
Let me add a little context. I am a social worker and community developer who has worked in various roles over the past 30 years: Community Action Agency and Association; grass-roots capacity building; Asset-based Community Development; appreciative inquiry; and most recently, in Medicaid managed care on social determinants of health and health equity. Across these different sectors, roles, programs, model designs, and initiatives to address social and community needs are the same scalable issues – siloed funding, reduced timeframes, and limited understanding of comprehensive and systemic supports and data.
However, intuitively, many of us know that there is meaning in this line of work and that we are on the brink of breakthroughs as we identify and address these challenges and bring systems, organizations, funding, and data closer together. Slowly, the metrics and the data are starting to align in a way to support the intuition.
Will a Whole-of-Government Approach Stick?
The whole-of-government approach could potentially be another fly-by-night notion or “pet project” of an administration that gains no traction. However, I recall back in 2015 when people told me that social determinants of health (SDOH) would not be around for long. It would soon go away. Social service programs have been adapted and replicated into managed care plans across the country to incorporate a version of SDOH programming that addresses food insecurity, housing/homelessness, transportation and education as a way to increase member engagement and overall health outcomes.
Look at where we are today. People told me that there was no way traditional Medicaid would ever pay for food or rent. Look what happened just this fall for the states of Oregon and Massachusetts with their approved Medicaid section 1115 Waivers. These Medicaid initiatives address continuous enrollment for eligible individuals, prevent gaps in coverage that can cause children to lose access to needed care in their early formative years, and take steps to address unmet health-related social needs. These include food assistance, housing, and other social supports. The Kaiser Family Foundation tracks all the Medicaid 1115 Waivers. Currently, 18 states have approved waivers, and eight have pending SDOH-focused waivers.
These partnerships and efforts that were outside the framework of traditional healthcare delivery services were not required, not paid for by Medicaid, and not part of the Managed Care contract. They were, however, part of building a strong community and examining if addressing social needs could impact Medicaid costs.
These social programs have not only been replicated by CareSource across its footprint. Several other managed care plans in the country incorporate a version of SDOH programming that addresses food insecurity, housing/homelessness, transportation, and education. However, managed care plans are struggling to identify the return on investment. I am excited about the prospect of the whole-of-government collaborative approach for this reason.
How Do We Move Forward Together?
There is significant work to be done to bring comprehensive services to the people who need them the most. We know where these people live. We know who is most in need. We have the data, technology, hot spots, heat maps, and zip codes to identify them. And I am a firm believer that we have enough resources in these safety net programs to move the needle much further, faster if we could come together. Right now, we have the focus and attention within Medicaid and Medicare, two of the largest safety net programs, to make changes to achieve health equity and reduce social determinants of health risk factors.
I look forward to taking what I have learned and implemented over the past 30 years and collaborating with those organizations ready to move the needle –those who envision the blending and braiding of partnerships, services, and policies to drive better health outcomes for patients, residents, participants, individuals, and families (no matter what word you use for the people you serve). I look forward to working with some of the brightest professionals in the healthcare industry at Clearlink Partners to utilize the new action plans coming out of the White House, the expanded health equity accreditation standards, and the innovation and demonstration projects from Centers for Medicare and Medicaid Services (CMS) and Centers for Disease Control and Prevention (CDC) to implement the whole-of-government approach. We can partner with health plans, health systems, state Medicaid programs, community development, and community-based organizations to develop the benefits, capabilities, and solutions to address the social drivers of health and see the return on investment. Together, we can identify what it takes to help solve hunger, homelessness, substance use disorder, mental illness, and unemployment in our communities that need it most while reducing care costs.
Health Equity is top of mind across all levels of government and healthcare for 2023. CMS released a new Health Equity Framework in November 2022. The National Association of Medicaid Directors (NAMD), which supports all Medicaid state offices, has promoted health equity initiatives through its events and publications throughout Q4 of 2022. And the National Committee for Quality Assurance (NCQA), which provides accreditation across all of healthcare, has added a formal Health Equity Accreditation process for health plans and health equity measures to 9 of the 21 Healthcare Effectiveness Data and Information Set (HEDIS), a set of measures designed to help healthcare consumers compare health plan performance measurements against industry benchmarks. Now is the time many of us have been waiting for, so let us pull together and not let it slip by. Now is the time many of us have been waiting for, so let us pull together and not let it slip by.