Samuel T Opoku, Charles F Owens, Bettye A Apenteng, Linda Kimsey, Angela H Peden
{"title":"State Expectations and Medicaid Managed Care Organizations' Efforts to Address the Social Needs of Medicaid Enrollees.","authors":"Samuel T Opoku, Charles F Owens, Bettye A Apenteng, Linda Kimsey, Angela H Peden","doi":"10.1177/10775587221096262","DOIUrl":null,"url":null,"abstract":"<p><p>Existing work on states' efforts to address the social needs of Medicaid enrollees indicate the implementation of several state-level strategies to move Medicaid Managed Care Organizations (MMCOs) toward the provision of whole-person care. However, less is known about how these expectations drive MMCOs' SDOH efforts. To address this gap, we interviewed representatives of eight MMCOs (<i>N</i>=28) and 12 state Medicaid offices (<i>N</i>=17). Participants described varying state-implemented instruments for encouraging an SDOH-focus among MMCOs, including both coercive (e.g., contractual mandates) and subtle approaches (e.g., request for proposal process and performance measurement expectations). However, regardless of states' expectations, MMCOs, driven by organizational and industry-related factors, recognized the importance of addressing SDOH as part of a holistic approach to health care. Collectively, regulatory pressures, organizational strategy, and market forces influenced MMCOs' efforts to address SDOH leading to a normalization of their role in addressing members' social needs within a medical paradigm.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":null,"pages":null},"PeriodicalIF":2.4000,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Medical Care Research and Review","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/10775587221096262","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
引用次数: 1
Abstract
Existing work on states' efforts to address the social needs of Medicaid enrollees indicate the implementation of several state-level strategies to move Medicaid Managed Care Organizations (MMCOs) toward the provision of whole-person care. However, less is known about how these expectations drive MMCOs' SDOH efforts. To address this gap, we interviewed representatives of eight MMCOs (N=28) and 12 state Medicaid offices (N=17). Participants described varying state-implemented instruments for encouraging an SDOH-focus among MMCOs, including both coercive (e.g., contractual mandates) and subtle approaches (e.g., request for proposal process and performance measurement expectations). However, regardless of states' expectations, MMCOs, driven by organizational and industry-related factors, recognized the importance of addressing SDOH as part of a holistic approach to health care. Collectively, regulatory pressures, organizational strategy, and market forces influenced MMCOs' efforts to address SDOH leading to a normalization of their role in addressing members' social needs within a medical paradigm.
期刊介绍:
Medical Care Research and Review (MCRR) is a peer-reviewed bi-monthly journal containing critical reviews of literature on organizational structure, economics, and the financing of health and medical care systems. MCRR also includes original empirical and theoretical research and trends to enable policy makers to make informed decisions, as well as to identify health care trends. This journal is a member of the Committee on Publication Ethics (COPE). Average time from submission to first decision: 25 days