News: SDOH payer coverage needs to be expanded, report says

According to a report published by the Bipartisan Policy Center (BPC), the U.S. Department of Health and Human Services (HHS) needs to expand the list of social determinants of health (SDOH) that public payers should cover. Additionally, the report notes that HHS should hold public payers accountable to covering preventative services that can help address SDOH.

The BPC report states that the country can improve “population health and health outcomes by integrating social services with the healthcare system and addressing SDOH before they lead to exacerbate chronic illness.” In order to do this, the BPC states that both the coverage of and access to primary care and preventative services need to be improved.

The agency recommends a “multifaceted approach that improves insurance coverage of preventative and nonmedical services in the Medicaid program and strengthens the primary care workforce through an independent evaluation of workforce shortages, greater use of telehealth and technology, and higher reimbursement rates for select services in Medicaid.”

For improving the coverage of SDOH, the BPC recommends HHS further expand the list of nonmedical services that Medicaid programs are allowed to cover. For example, anything that has proof of enhancing or sustaining health outcomes should be included in coverage.

The BPC has urged HHS to offer more financial support for studies that offer proof for nonmedical services improving health outcomes. The agency also recommends public payers should be held accountable for covering preventative care services to address SDOH when they are initially found.

Additionally, the BPC report suggest CMS should release guidance around community health worker (CHW) reimbursement. “Coverage of CHWs has proven to be effective in addressing health care disparities in minority and underserved communities, improving outcomes, and reducing Medicaid costs for some populations and conditions,” the report stated.

Finally, the report recommended integrating clinical and community-based services, and that tools for EHRs, telehealth, and remote patient monitoring will be essential.

Editor’s note: To read the complete BPC report, click here. Additional ACDIS coverage of SDOH efforts can be found here.