New Marketplace
Clip
A Holistic Approach to Social Needs (03:08)

Given politics and tight state budgets, how much can Medicaid actually do to address social determinants of health? Is it the responsibility of health care to pay for someone’s social needs, or that of another sector?

“That’s a tough question,” says William Golden, Medical Director for Arkansas Medicaid. Commercial managed care could theoretically buy a refrigerator for someone who can’t store their insulin, for example, but it would be difficult for a state-based program to justify that purchase to its legislature.

“On the other hand, there are lots of opportunities evolving where the division of Health and Human Services in a state starts to collaborate with the corrections institute or starts collaborating with the Department of Education,” says Golden. “There are opportunities across state agencies that can make a difference, which have not been exploited.”

Sachin Jain, CareMore Health System’s President and CEO, agrees, offering the Nurse-Family Partnership as an example. The program, which pairs nurses with first-time single mothers, has shown reduced use of special education, yet it is nationally underfunded because its benefits don’t necessarily accrue to the same buckets — savings accrue to the education system, while costs accrue to health care. “If you view it purely as a health care intervention it’s wildly expensive,” says Jain, “but when you view it as a social intervention that bridges sectors, it’s actually potentially cost-saving for states.”

“Sometimes we take too narrow a view of what health care is and too narrow a view of what education is, or housing,” Jain adds. “We need to start looking at these things more holistically.”

The same dynamic occurs across Medicaid and Medicare, says Anya Rader Wallack, Rhode Island’s former Medicaid Director. If Medicaid tries to save money on acute care, such as reduced hospitalizations, that benefit largely accrues to Medicare. “The flip side is, if Medicare doesn’t take care of somebody, and they end up eventually in a nursing home and spend down to Medicaid level, that’s my problem,” she says.

From the NEJM Catalyst event New Risk, New Business Models held in Boston, October 6, 2016.

More From New Marketplace

What Is Risk Management in Healthcare?

Healthcare risk management comprises the systems and processes employed to uncover, mitigate, and prevent risks in healthcare institutions. Understand its purpose, elements, the risk manager’s role, and more.

ED Telehealth Express Care Service Patient Room

Revolutionizing the Delivery of Care for ED Patients

How the NYP OnDemand Emergency Department Telehealth Express Care Service reduced stay times and revisit rates in one year.

Targeting Unconscionable Prescription-Drug Prices — Maryland’s Anti–Price-Gouging Law

Why, in the early 21st century, are so many drugs that were cheaply available in the 20th century becoming prohibitively expensive?

The Economics of Indication-Based Drug Pricing

What would indication-based drug pricing accomplish?

Controlling the Cost of Medicaid

Both political parties should support policies that focus on incentives as a mechanism for improving and sustaining their value.

Resetting the Nation’s Health Care Quality Agenda

Poor measures of care quality have consequences. The National Quality Forum is essential to creating measures that are valid and reliable.

Untapped Business Opportunities for Entrepreneurs in Delivery System Reform

Opportunities for Private-Sector Entrepreneurship in Health Care Transformation

Two veterans of public service say that government can do only so much — which creates attractive business opportunities for entrepreneurs.

Moving Past the EHR Interoperability Blame Game

Why can't EHRs talk to one another? We never created the right incentives, but we pretend that we did.

Emerging from EHR Purgatory — Moving from Process to Outcomes

What's the effect of the mode of physician payment when it comes to EHRs?

Reframing Analytics: Transforming Insights into Action

Centralizing clinical data for an integrated delivery system revealed a surprising lesson: sometimes predictive analytics are not enough.

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

Topics

Prescription for an Ailing U.S. Health…

Three components for treating the unhealthy, uncompetitive U.S. health care market — beginning with a…

Value Based Care

194 Articles

A New Model for Pricing Drugs…

Are we paying too much for new drugs before we know how well they work?…

A New Model for Pricing Drugs…

Are we paying too much for new drugs before we know how well they work?…

Insights Council

Have a voice. Join other health care leaders effecting change, shaping tomorrow.

Apply Now