Examining the factors constraining Medicaid managed care organizations’ efforts to address social determinants of health (SDOH)

<p> <strong> Background </strong></p><p> The Medicaid population is a socially vulnerable population, with significant social and economic needs. Efforts to address medical needs of this population are often futile without consideration of social needs. Medicaid Managed Care Organizations (MMCOs) are increasingly taking a leadership role in the integration of social and health services. This study describes constraints to MMCOs&rsquo; efforts to address the social needs of Medicaid beneficiaries.</p><p> <strong> Objectives </strong> <ol> <li> Describe the challenges experienced by MMCOs in their efforts to address the social needs of Medicaid beneficiaries. </li> <li> Describe how MMCOs have navigated challenges arising from efforts to address the social needs of Medicaid beneficiaries. </li> </ol></p><p> <strong> Methods </strong></p><p> This was a qualitative study using data obtained from interviews conducted with 26 representatives of eight national and regional MMCOs. Participants included plan senior executives, medical directors, directors of case management, directors of legal and regulatory affairs departments and directors and staff of dedicated programs to address social needs of members. Interviews were audio-recorded and transcribed, and transcripts analyzed using thematic analysis.</p><p> <strong> Results </strong></p><p> Participants reported challenges in the process of engaging stakeholders and delivery systems in efforts to address SDOH. Challenges were classified under the following emerging themes: (a) member engagement and retention challenges; (b) resource and capacity limitations; (c) challenges associated with developing and sustaining community-based partnerships; (d) data-related challenges; (e) prevailing paradigms for healthcare delivery; (f) silo mentality and lack of collaboration among stakeholders; and (f) difficulties in demonstrating the impact of SDOH investments. Participants described strategies for navigating each of these challenges, including relationship and coalition building, stakeholder education and advocacy, and strategic prioritization of resources.</p><p> <strong> Conclusion </strong></p><p> The findings from this study suggest the presence of several constraints to MMCOs&rsquo; ability to effectively address the social needs of Medicaid beneficiaries. Efforts to mitigate these challenges are needed for MMCOs to deliver &ldquo;whole-person&rdquo; care effectively and efficiently</p>