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Social Determinants of Health Webinar Describes Role of CBOs in Value-Based Payment

The Department of Health (DOH) hosted a webinar last week to educate community-based organizations (CBOs) about opportunities to support value-based payment (VBP) arrangements through contracts with managed care organizations (MCOs). Under New York State's Medicaid VBP Roadmap, Medicaid managed care plans (including managed long term care (MLTC) plans) must implement shared risk arrangements with providers. As they move into two-sided risk (i.e., shared savings and shared losses, or in the case of MLTC, bonuses and penalties), those arrangements must include a social determinants of health intervention and a contract with a CBO. The webinar slides are available here.

Social determinants of health (SDH) are "the structural conditions in which people are born, live, grow, work, and age." Research has shown that social determinants can have a significant impact on health outcomes. DOH has identified five categories of SDH that MCOs may opt to address through VBP arrangements:

  1. Education
  2. Social and Community Context
  3. Health and Healthcare (including health literacy, wellness coaching, care navigation)
  4. Neighborhood and Environment (including access to healthy foods and transportation)
  5. Economic Stability (including housing)

Although MCO VBP arrangements that involve two-sided risk must include an SDH intervention and at least one CBO, the CBO need not be a participant in the selected intervention. The CBO must, however, be a "Tier 1" CBO – a CBO that does not otherwise bill Medicaid. In addition to Tier 1 CBOs, Tier 2 and Tier 3 CBOs may also be engaged in SDH interventions. CBOs may contract directly with MCOs or may contract with Medicaid providers engaged in VBP arrangements. CBOs may partner with each other to offer more comprehensive interventions to MCOs and VBP providers. CBO contracts are not required to include risk – they may be fee-for-service arrangements. The webinar includes useful information about contracting options and strategies.

A directory of CBOs and their tiers is available here. The directory is updated biweekly by DOH based on responses to a survey. LeadingAge NY members that provide community services for seniors are encouraged to submit their program information to DOH through the survey tool. Those that do not bill Medicaid may qualify as Tier 1 CBOs. A menu of potential SDH interventions is available here. The menu is not intended to be exhaustive, and DOH is actively soliciting additional interventions.

The SDH program requirements have been developed principally based on the needs and covered benefits of mainstream managed care plans and their non-aged beneficiaries. As MLTC plans move into higher levels of risk, LeadingAge NY is working with the Department to tailor the program requirements and funding to align with MLTC benefits and members. Additional information about the SDH requirements under New York's VBP Roadmap is available in the VBP Resource Library under the "Social Determinants of Health and Community-Based Organizations" tab.

Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8838