An individual’s health is shaped profoundly by life circumstances that fall outside the traditional purview of the health care system. Family support systems, housing, nutrition, income, education, and other dynamics are often collectively referred to as “social determinants of health.”
Social determinants are defined by the World Health Organization as the conditions in which people are born, grow, live, work, and age. In a 2008 report, the World Health Organization Commission on Social Determinants of Health cited these factors as collectively having the most significant influence on health outcomes. Other studies have indicated that nearly 70 percent of health outcomes are attributed to behavior and environment.
The 58 members of the Association for Community Affiliated Plans (ACAP) share a strong commitment to addressing the social determinants that may adversely affect members’ health. ACAP health plans often invest substantially in innovative initiatives that, while outside the confines of the health benefits traditionally covered by Medicaid or other insurance programs, directly address social determinants that in turn have a significant (although indirect) impact on health outcomes and health care costs.
This report seeks to follow the five key areas of social determinants as outlined by Healthy People 2020, an initiative by the Department of Health and Human Services. These areas include neighborhood and built environment, economic stability, education, food security, social and community context, as well as health and health care. Medicaid health plans inherently provide the health and health care aspect of social determinants in ensuring access to comprehensive primary care and other health services. This report will describe programs in which ACAP health plans are innovatively and positively impacting the other key areas of social determinants to improve health outcomes.
Despite operating within fiscal constraints – and including a need for the State to achieve net Medicaid
savings through their partnership with each Medicaid health plan — the ACAP plans have demonstrated a commitment and ability to innovate in the social determinants arena.