Medicaid accountable care organizations (ACOs) are designed to improve health care quality while delivering more efficient care. But, medical care is only one of several factors affecting health outcomes. Social determinants of health (SDOH), such as living environment and access to healthy food, affect health outcomes and, consequently, an ACO’s bottom line. Because most ACOs are ultimately responsible for total cost of care and quality, ACOs have a clear business case to address SDOH.
State Approaches to Addressing SDOH through Medicaid ACOs
Of the 12 early innovator states that have launched statewide Medicaid ACO programs, many have identified SDOH as a critical issue. These states are shaping Medicaid ACO efforts to address SDOH by: (1) encouraging or requiring SDOH interventions; (2) developing risk adjustment strategies; (3) recruiting SDOH-savvy ACOs; and (4) encouraging or requiring community partnerships. In response to these state policies, Medicaid ACOs coordinate care, collect data, integrate services, and build partnerships that align with the state’s SDOH priorities.