Kim Webb
New research from the Commonwealth Fund painfully confirms once again a truth we have long known: the U.S. healthcare system is inequitable. Attend any healthcare conference in recent years and you would be sure to find numerous panels dedicated to pondering the solution to this issue. What if the answer to take a holistic approach has been in front of us this entire time?
As described in the Commonwealth Fund report, equity reflects how people with below-average and above-average incomes experience healthcare in their communities. Income greatly impacts factors like housing instability, educational attainment, and employment – known as Health-Related Social Needs (HRSNs). While HRSNs aren’t new to the healthcare sector, nowhere do these factors have a greater health impact than within the Medicaid community, and using them to create more equitable healthcare structures continues to be the missing link.
Individuals on Medicaid are particularly vulnerable to health inequities as socioeconomic challenges like income constraints and insecure living environments block access to care or accelerate chronic conditions. While federal healthcare programs focus their attention on ensuring healthcare resources exist for communities in need, HRSNs become critical drivers of whether individuals can actually access and benefit from these resources.
Preventative care is the first to fall
A KFF poll from March 2022 revealed that 43% of adults reported either they or a family member in their household delayed or skipped necessary healthcare due to cost concerns – a number that’s continuing to increase alongside overall healthcare expenditures. Medicaid recipients may also have less flexible work schedules and limited transportation options, creating barriers for them to access and receive preventive and timely care. This scenario is pervasive in the US as 3.6 million Americans live with health-related transportation insecurity, disproportionately impacting individuals with Medicaid benefits.
When patients skip preventative care, the long-term health consequences are staggering. Routine check-ups and early screenings are the cornerstone of preventative medicine, allowing for the detection of conditions like diabetes, hypertension, or cancer at an early stage, when treatment is more effective and less costly. Without these regular touchpoints, manageable conditions can quickly become critical and end up costing plans more in medical expenditures over time.
By addressing social needs, Medicaid plans can help ensure their members have the resources to attend regular check-ups and screenings. Investments like transportation reimbursement, while initially costly, frequently result in long-term savings by reducing the need for expensive emergency interventions and chronic disease management. Given the link between HRSNs and access to preventative care, it’s easy to wonder why leveraging member’s HRSN data has not played a larger role for Medicaid plans until this point.
What’s preventing action from plans
Despite the clear link between HRSNs and health outcomes, many Medicaid plans have struggled to act on HRSN data due to limited resources and structural barriers. Community health plans that have budget constraints might execute a reactive strategy where money is allocated strictly toward medically necessary care. Operating with a shorter-term financial planning strategy also gets in the way of prioritizing preventative care that reduces long-term costs yet may take longer to materialize.
But the key challenge lies in understanding the specific needs of varying Medicaid populations. It’s abundantly clear that health needs vary based on circumstances like geography, gender, and socioeconomic status – however plans still struggle with identifying which of these factors are impacting the specific communities they serve. The rural low-income communities in Georgia surely need different considerations than those living on the outskirts of NYC. For Medicaid plans to truly tackle health inequities, they must understand the unique needs of their members. Only then can they more effectively allocate their budget to prioritize the appropriate services and support to reduce long-term costs.
A new opportunity to act
As Medicaid redetermination causes membership shifts in many plans, a new and urgent opportunity emerges to reassess members’ needs, including critically, their social needs. Plans that take the opportunity to gather the HRSN data of their members to better understand their needs can move from a one-size-fits-all approach to a more personalized care strategy that reflects the unique circumstances of each member.
New York recently took a big step in the right direction, with a new proposal requiring demographic data collection to identify the overlooked needs of different communities aiming to address gaps in access to care. But like HRSN data, it’s what we do with this information that matters most.
As we prepare for the 2025 and 2026 panels on health equity, let us begin utilizing the resources readily available to understand how our health system can better serve the most vulnerable populations and address the key barriers to care that persist.
Photo credit: Andrii Shyp, Getty Images
Kim Webb is the Vice President of Health Strategy at Siftwell Analytics where she serves as the strategic thought partner with plan and community stakeholders and helps to guide Siftwell’s development of solutions that improve the health and wellness of vulnerable populations. Previously, she was the Enterprise Vice President for Population Health and Clinical Operations at AmeriHealth Caritas, where she led a team of 1,000 associates across 15 Medicaid, Marketplace and Medicare markets. Her previous experience includes serving as National Director for Magellan Health’s Clinical Center of Excellence, as well as clinical operations, care delivery implementation, clinical programs, and strategy roles with Evolent Health, CareFirst BCBS and Novartis. Kim earned a Master of Science in Population Health Management from Johns Hopkins Bloomberg School of Public Health and upon graduation was commissioned into the U.S. Air Force serving five years on active duty as a nurse.
This post appears through the MedCity Influencers program. Anyone can publish their perspective on business and innovation in healthcare on MedCity News through MedCity Influencers. Click here to find out how.