The COVID-19 pandemic has greatly magnified a link that healthcare policymakers and stakeholders have long understood: social determinants of health (SDOH), medical utilization, healthcare spending, and health outcomes are tightly correlated. This link becomes increasingly evident for vulnerable and high-need, high-cost populations such as underserved communities, low income, and dually eligible individuals. Pre-pandemic, state policymakers were already deploying numerous strategies to support higher flexibility in healthcare spending to focus on social domains such as Economic Stability, Education Access and Quality, Healthcare Access and Quality, Neighborhood and Built Environment, and Social Community Context and to integrate these factors into the healthcare payment system. As the country move towards post-pandemic recovery, these strategies remain important tools for States to leverage. Examples include the use of Home and Community-Based Services (HCBS, 1915c) waivers and the introduction of performance-based and value-based payment (VBP) mechanisms.
This paper explores the options available to state and local governments to accelerate the integration between healthcare and social programs with the objective of better addressing SDOH and improving overall efficacy and quality of the patient care continuum.