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As noted in the first article in this series, traditional value-based (VBC) care models are largely focused on economic incentives to healthcare providers and facilities. Many VBC organizations lack the infrastructure in place or scale to integrate factors that impact how patients interact with the healthcare system, engage with care providers, or adhere to treatment recommendations. Failure to consider and address these needs can create obstacles to realizing the full economic and health goals of traditional VBC models.
For example, social determinants of health (SDoH), including safe housing, transportation, and neighborhoods; racism, discrimination, and violence; education, job opportunities, and income; access to nutritious foods and physical activity opportunities; polluted air/water; and language and literacy skills, impact more than half of all health outcomes. In fact, it is estimated that aspects other than individual health exceed health-related factors with respect to driving population health outcomes. One study found that sociocultural, logistical, and financial factors impact medication adherence, which is a key driver of health outcomes.
Overcoming these obstacles requires both novel VBC models as well moving care beyond the clinic walls to meet patients where they are. Some public health initiatives have made significant strides toward improving access, quality, and cost-effectiveness of health services. For example, New York State’s 115 Medicaid Redesign Team (MRT) Waiver allows the State to implement a managed care program that provides comprehensive and coordinated health care to Medicaid recipients, improving these individuals’ overall health coverage. One component of the program, the MRT Supportive Housing Initiative, addresses housing-related SDoH by providing supportive housing to high-need Medicaid participants through rental subsidies, supportive housing services, and capital projects.