Medicaid Managed Care for Members with Mental Health Conditions and/or Substance Use Disorders: Connecting Members to Social Supports

Tuesday, December 13, 2016
Summary and Key Findings: 

For Medicaid members who are diagnosed with mental health conditions and/or substance use disorders (MH/SUD), effective, high-quality behavioral and physical health care is only one part of improving their overall wellness. These individuals also face challenges in securing stable housing, gaining meaningful employment, and navigating a range of financial and day-to-day challenges. Addressing these concerns as well as medical needs has been shown to improve health and wellbeing.

The Anthem Public Policy Institute recently released a white paper, Medicaid Managed Care for Members with Mental Health Conditions and/or Substance Use Disorders: Connecting Members to Social Supports, which demonstrates how Medicaid managed care organizations (MCOs) are connecting members with MH/SUD to community resources to help meet their social and economic needs and improve their overall health outcomes. 

The role of managed care in connecting members to social supports

MCOs play a crucial part in connecting Medicaid members with MH/SUD to social supports available in their communities. The term “social supports” refers to any non-medical services that can play a role in improving an individual’s physical and mental health. They can include community-based services related to housing, food assistance, employment programs, education and vocational training, legal and financial services, and transportation, among others.

In addition to the growing body of research suggesting that social and economic circumstances drive health outcomes as much as, if not more than, clinical interventions, there are a number of factors that contribute to the expanded efforts of MCOs to connect members with social supports, including:

  • Sharp growth in the number of adults without children who now qualify for Medicaid and who are more likely to require comprehensive social supports
  • States’ expansion of managed care to “non-traditional” and more complex populations (i.e., individuals with disabilities, dual eligible beneficiaries, children in foster care, etc.)
  • Focus on value-based payment models encouraging MCOs to diversify and think innovatively about the services that are necessary to improve health outcomes

To better assist members in accessing community resources, MCOs have expanded the role of case managers and are thinking about new ways to help make these connections for their members. MCOs have varied approaches, but the key elements include:

  • Inclusion of social needs in initial assessments
  • Care management plans that include social supports
  • Comprehensive approaches to identifying social supports
  • Recruitment of case managers with experience in the community

Opportunities and challenges in connecting members to social supports

Few refute the fact that connecting Medicaid members with MH/SUD is a critical component in improving outcomes. There are, however, opportunities and challenges for MCOs as they determine how best to make these connections, which include:

  • Identifying the most effective way to facilitate access to social supports, including avoiding duplication of efforts by other providers or agencies
  • Building new partnerships with social service organizations and addressing silos that sometimes exist between health care and social service providers
  • Developing more sophisticated tools and strategies for connecting members with personalized supports
  • Hiring staff with diverse experience and expertise
  • Responding to lack of housing, education, job training and other social supports in many parts of the country

As MCOs further develop tools and strategies for addressing social support needs, they must evaluate how their efforts improve health outcomes, reduce growth in health care spending, and improve stability, quality of life, and wellbeing of their members. 

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