Medicaid Beneficiaries Do Much Better When Plans Address Their Social Determinants of Health

A study conducted by the Medicaid plan AmeriHealth Caritas confirms what the company’s leaders say they’ve long known intuitively.

Fred Hill, MD, AmeriHealth Caritas’s senior vice president of population health puts it this way: “In our many decades as a community-focused organization, we intuitively understood what the data reveals: that there is a clear relationship between poor health and socioeconomic factors such as employment status, income and nutrition,” Hill said in a press release.

The Medicaid health plan analyzed outcomes data of about 1,000 beneficiaries in the last quarter of 2018. Those in the study had one or more chronic conditions including diabetes, cardiovascular disease, and high blood pressure.

In addition to outcomes data, researchers looked at claims data and hospital utilization rates, as well. Data were also collected from surveys about the social determinants of health (SDOH). What AmeriHealth Caritas found was that SDOH matters—a lot.

When members received community-based SDOH services alongside clinical help this is what happened:

 

A 26.3% drop in inpatient admissions.

A 27.2% reduction in inpatient days.

A 9.7% drop in emergency department visits.

A 22% reduction in potentially preventable admissions.

A 12% reduction in potentially preventable emergency department visits.

 

AmeriHealth Caritas’s community wellness centers help members track and assess the status of their chronic diseases. They also provide screening and lifestyle coaching, and connect members to community organizations that can address their SDOH needs.