Addressing Social Needs Boosts Healthcare for the Poor

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New York State launches new phase of Medicaid innovation

Calling especially for awareness of how social factors can impact health—and insisting on tackling the Social Determinants of Health—the federal government has approved a new Medicaid 1115 Waiver for New York State, making $6B available to improve the quality of Medicaid care in the state in a variety of ways. Officially beginning in April 2024 and concluding on March 31, 2027, the new waiver program puts a premium on the delivery of Health-Related Social Needs (HRSN) services, which is allotted almost half of the budget.

The push for taking HRSN factors into account is at the heart of the waiver's vision to promote health equity, reduce health disparities, and sharply improve the quality of Medicaid-funded health care across the board—putting in place mechanisms that are designed to become a lasting part of Medicaid in New York State, including, especially, the official inclusion in Medicaid of a budget to tackle HRSN.

The program will provide funding enabling primary care providers to engage Community-Based Organizations (CBOs) to find solutions for social needs that are harming the population's health. There will be a regional approach that will single out areas that have historically seen health disparities and disengagement from the healthcare system. The waiver also calls for the integration of primary care, behavioral health, and awareness of HRSN, particularly as regards high-risk Medicaid recipients, such as youth, pregnant women, those struggling with addiction issues, and the chronically homeless. The waiver envisions Social Care Networks (SCN) to oversee the HRSN programming, working with local social care providers.

The waiver also includes more than $690M to be spent on New York State's healthcare workforce to stabilize the workforce, provide training and education, and improve access to culturally appropriate services. Training the workforce—including physician assistants, mental health counselors, and Community Health Workers—will also feature the introduction of Value-Based Payment models, even as the waiver calls for an increase in fee-for-service payments. Some doctors who sign up for a multi-year commitment to work with Medicaid patients will receive student loan repayment.

A Health Equity Regional Organization (HERO) will use data gathering and analytics to design formulas to reduce health disparities, as well as support the delivery of HRSN services. This entity will also explore different Value-Based Care models that include coverage of HRSN services. SOMOS Community Care—a network of 2500 independent physicians, most of them primary care providers serving the poorest Medicaid patients in New York City—applauds the new 1115 Waiver.

It welcomes the emphasis on integrating Health-Related Social Needs (HRSN) services in overall healthcare as key to overcoming healthcare disparities and creating health equity. In fact, SOMOS has pursued such a model of health care since it got its start in 2014 as an entity mandated by the previous 1115 Waiver. As it stands, SOMOS recognizes itself in the blueprint of the new Waiver. That is true in several key areas.

Thanks to the work of CHWs who visit patients' homes, providers have intelligence about social conditions affecting patients' lives. SOMOS doctors have already begun reaching out to CBOs, as called for by the waiver. Additional funding for the training of CHWs, as well as for physician staff, among other key positions, is much needed. The waiver's workforce investment is much needed.

While Social Care Networks (SCN) are envisioned to organize HRSN programming as delivered by local social care providers, the patients who qualify for such care must first be identified by the family doctor who knows his and her patients intimately. It is also conceivable that SOMOS doctors' practices in the Bronx, Manhattan, Queens, and Brooklyn form hubs in their networks that identify and seek help for patients needing HRSN services. It seems clear that medical providers must—alongside social care experts—participate somehow in the SCN networks.
SOMOS has also pioneered Value-Based Payment. Its experience can be fruitful for the specialists charged with exploring VBP models that will be key to statewide accountability for improving health care, patients' longer-term well-being, and health equity.

The fundamental goal of the waiver is to better serve the poor, the vulnerable, and the most disadvantaged. SOMOS doctors are community-based and accessible to their patients, and in many cases, share a cultural identity with them, which is most conducive to a strong relationship between doctor and patient—a bond that plays an important role in the quality of care. SOMOS doctors have been providing superior care—medical, behavioral, social—to their patients while saving taxpayers money in the process.

Moreover, SOMOS has operated as the only network of independent providers in the state. It has no backing from a hospital conglomerate. Instead, it has operated in the trenches. The new 1115 Waiver promises new growth as well as challenges for SOMOS—and its doctors and staff will continue to give their all, as they have done from the very start of the reinvention of Medicaid.

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Mario J. Paredes is CEO of SOMOS Community Care, a social care network of over 2,500 independent providers responsible for reaching and delivering care to over 1 million Medicaid lives across New York City.

 

 

May No Sick Person Be Alone!

On May 13, 1992, then-Pope John Paul II established February 11 as the World Day of the Sick, an annual occasion for prayer and reflection and for promoting the assistance and care that is needed – worldwide – for all those who do not enjoy good and complete health.

Every year since then, the Pope has enlivened this Day with a Message in which he encourages us to live life adopting a compassionate and merciful gaze and attitude – like Jesus himself – towards our brothers and sisters who suffer from some kind of illness, towards “all of you, brothers in trial, who are visited by suffering under a thousand forms, who search in vain for the why of human suffering and who ask anxiously when and whence will come relief.” (Closing of the Second Vatican Ecumenical Council – To the Poor, the Sick and the Suffering – 8 December 1965).

Health is a condition for personal, family, and social life. Without health, there is no full life, there is no “abundant life” (Jn 101:10). When we lack health, we are put in a situation of need, fragility, and vulnerability.

So important is health for the human being, that – theologically speaking – God’s salvation for man is synonymous with health. For this reason, the messianic times of the coming of the salvation that God offers us in his Son Jesus Christ are announced, both in the Old Testament, as times of salvation in which “the blind regain their sight, the lame walk, lepers are cleansed, the deaf hear, the dead are raised, and the poor have the good news proclaimed to them” (Mt 11:4-6).

While health care and the preferential attention that the sick must have in every society are important, the institutions and people who dedicate themselves to health care through the exercise of the medical profession are equally important.

I am the CEO of SOMOS Community Care, a network that coordinates more than 2,500 family physicians to provide primary care services to New York City’s most disadvantaged. In this medical organization, we work toward a humanistic vision and mission that views health care from a comprehensive, preventive perspective. We are aware of the importance of personal and collective health care, and we make our best efforts to ensure that our medical, human, and material resources reach those who need them most.

For this reason, among other expanded social welfare projects, the SOMOS Community Care Medical Organization and the Doctor Ramon Tallaj Foundation have implemented a scholarship system for students with academic excellence who, without this support, would not be able to achieve their academic goals of completing their studies in medical and paramedical programs.

For this 32nd World Day of the Sick, on February 11, 2024, Pope Francis’ Message is inspired by the biblical quote, “It is not good for the man to be alone.” (Gen 2:18). Because, says the Pope, “Our lives … are meant to attain fulfillment through a network of relationships, friendships, and love, both given and received. We were created to be together, not alone. Precisely because this project of communion is so deeply rooted in the human heart, we see the experience of abandonment and solitude as something frightening, painful, and even inhuman. This is even more the case at times of vulnerability, uncertainty, and insecurity, caused often by the onset of a serious illness.” For this reason, the Pope summons us all to solidarity, to a closeness with compassion and tenderness.

A society that abandons and forgets those who suffer is also a sick society, in need of health and salvation. “This grim reality is mainly a consequence of the culture of individualism that exalts productivity at all costs, cultivates the myth of efficiency, and proves indifferent, even callous, when individuals no longer have the strength needed to keep pace. It then becomes a throwaway culture in which “persons are no longer seen as a paramount value to be cared for and respected, especially when they are poor or disabled…” (Fratelli Tutti, 18). 

Thus, we are all called to live in the commandment of love, love that simultaneously heals the sick, a love that heals and saves those of us who forget our brothers and sisters in need and those who care for and soothe – from the field of medicine – those who suffer in hospitals.

Let us ask ourselves, in addition to praying, what we can do to ease the burdens of those who suffer most in our society, how we can make the loneliness of the sick and elderly more bearable, how we can lessen the pain of so many brothers and sisters who suffer and in so many ways, because “it is not good for human beings to be alone.”

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Mario J. Paredes is a member of the Board of Directors of the Latin American Academy of Catholic Leaders and a Member of the Board of the American Bible Society. He is CEO of SOMOS Community Care, a social care network of over 2,500 independent providers responsible for reaching and delivering care to over 1 million Medicaid lives across New York City.

 

A blessing from God for the Church and for our country

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