CT Medicaid primary care redesign evidence: Part 1 Connecting with community services to improve health

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Connecticut Medicaid is considering reforms to primary care delivery and payment. The CT Health Policy Project is collecting evidence from other states and programs to help inform that planning.

A recurring theme of supporting non-medical, community services has emerged in feedback across planning groups. That feedback reflects the evidence that the social circumstances of people’s lives contribute far more to their health status than medical care.

DSS has made addressing patients’ social needs a main goal of reform.

• “Improve the biopsychosocial health and well-being of our members – especially for our most historically disadvantaged members and in a way that reduces inequities and racial disparities.”

DSS’s presentations to the Primary Care Program Advisory Committee have outlined plans to connect primary care and social needs, including the goal that:

• Providers are expected to fully address member needs and take accountability for member outcomes by providing culturally competent and inclusive treatment, enhancing access, strengthening care coordination, integrating behavioral health care, and better identifying and addressing members’ social determinant of health needs”

DSS’s strategy for achieving that goal is:

• “Primary care payment reform will build on this by giving primary care providers the flexibility and incentives to:
  • Identify members’ health related social needs
  • Refer members to providers who can help address these needs
  • Assist members in arranging for and obtaining HRSN [health related social need] services”

In Connecticut and nationally ,there is a great deal of interest in connecting primary healthcare with community services to improve health outcomes. Unfortunately, the published literature doesn’t offer much guidance on how to effectively make those connections.

Programs linking primary care and community services are relatively new, vary enormously, and evaluations to date have found disappointing results. Programs differ in important features including defining eligible patients, qualifications and training of case managers and navigators, the range of health and social needs included, and direct assistance vs. only referrals. There are themes in the literature and evidence about what doesn’t work.

Connecticut needs to go slowly and carefully in developing a plan. Simply following other states is not likely to work. DSS must screen options, consider Connecticut’s context, get stakeholder feedback, pilot, and evaluate options for linkage, learn and revise programs as necessary. Connecticut must also devote more resources to building community service capacity; referrals to waiting lists are not helpful. And any savings, if they occur, must be channeled back to the community services that generated them, rather than to the medical system.