Wednesday, May 14, 2014

Poverty and the Social Determinants of Poor Health

Guest Post Via Healthify

“Healthcare crisis,” “disparity” and “poverty” are popular words these days in American journalism and the blogosphere despite the recovering economy and the rocky implementation of the Accountable Care Act. A return to growth and expanded coverage should be good news. Poverty should be alleviated and health outcomes improving under such auspicious circumstances. What’s gone so wrong that it still gets the pundits so hot and bothered?

More Americans are enrolled in Medicaid than in any other point since its creation over forty years ago. Forty-two million have enrolled in managed care plans, 74.22% of beneficiaries–the highest percentage it has ever been (Medicaid Managed Care Enrollment Report). The increase in Medicaid beneficiaries is due to two main reasons:

1) The expansion of Medicaid services in 26 states to 138% of the federal poverty level; and
2) The dramatic increase in poverty and wage stagnation following the crippling financial crisis that started in 2007.

These patients range from the country’s most impoverished who are struggling to get by to lower-middle income earners who are fighting to stave off poverty as they float between Medicaid and health information exchange plans.

The increase of poverty and enrollment in Medicaid managed care is both boon and bane for Managed Care Organizations. Revenues will increase steadily as more beneficiaries elect their managed care plan. Unfortunately, the influx of new members, many of whom suffer disproportionately from issues related to the social determinants of health, will put pressure on existing healthcare infrastructure. These patient populations are more likely to suffer from insufficient food, substance abuse, and housing instability than other members and are less likely to have support when attempting to resolve these issues. This leads to an overutilization of services like emergency care at high cost with little gain.

Healthify helps MCOs deal with this critical issue by addressing their members’ social health needs. Our engineering team has developed a dynamic web-based screening tool to assess a member’s social and behavioral health risks at the point of care. Once our software identifies a members’ needs, it automatically connects them to our database of the best federal, state, and community programs that treat those needs. In a week’s time, we send out an interactive text message to see if they accessed the service and whether or not they found it useful. This end-to-end solution improves member referrals, satisfaction, and long-term health outcomes.

 What truly makes Healthify’s software so robust are the tools that we offer the care team through our dashboard. We provide the care team with access to our resource database so they can continually update, modify, or add resources to better help their patients manage their needs. More importantly, however, the care team can see trends in their member population’s health through the dashboard and access individual records to send out and respond to messages. We use this as an ideal opportunity to measure patient engagement on behalf of the care team; it also gives them better lines of communication to interact with their case manager, further improving member satisfaction.

Stop by Healthify’s booth at the 2014 Medicaid Managed Care Congress. Our team will be there to highlight how:

• Healthify’s service helps Medicaid managed care better manage the care of their members by addressing the social determinants of health;
• Our software platform helps care teams better care for members and help members more easily access services to help alleviate their needs; and
• We can reduce the cost of care per member per month by 2-6% while improving care quality and patient satisfaction.

Come and tell us what some of your members’ biggest social health risks are. We’ll be ready to help. In the meantime, check us out at


The 22nd Annual Medicaid Managed Care Congress is taking place next week (May 19-21) in Baltimore, MD - Don't miss out on the largest MMCC ever! It is not too late to register, save 15% when registering with the code XP1926BLOG.

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