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.
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.
