Health plans argue they are the best group to manage and receive funding from the CMS if it decides to pay for housing, transportation and other social determinants of health.
HHS Secretary Alex Azar shook up the industry when he remarked last month that the agency is putting together a pilot model that would allow healthcare organizations to bill the CMS for providing services such as assistance with food and housing.
And although details about the program are unknown at this time, it didn't take long for health systems to speak out and say they would be smart benefactors of such a payment.
Payers beg to differ.
Health plans—particularly those caring for Medicaid beneficiaries— think they should be the ones getting paid by the CMS for managing social determinants of health, given their access to members no matter the care setting, their experience in taking on risk and the work they are already doing to address members' social risk factors.
“We have the population. You should start with the health plan because they have all the members,” said Michael Schrader, CEO of CalOptima, a Medicaid and Medicare health plan based in Orange County, Calif. “You can go to a hospital, but all services don't happen at the hospital. Hospitals are only going to touch a small number of our members in any given year.”
Hospital industry representatives, though, argue their connection to the community is one of the reasons why they should be a major part of managing social determinants. “America's hospitals and health systems are leading the way in addressing the social determinants of health,” said Joanna Hiatt Kim, vice president of payment policy at the American Hospital Association. Kim said the AHA supports an enhanced version of the Center for Medicare & Medicaid Innovation's Accountable Health Communities model, which involves providers working with community groups to address patient's social risk factors. Health plans aren't part of the model at this time.
“The AHA will continue to prioritize supporting hospitals, health systems and clinicians as they address social determinants of health, work to eliminate healthcare disparities and provide comprehensive care to every patient in every community,” Kim added.
HHS' plans are unclear. Azar's comments about the model were vague and didn't directly address who would receive the payments. At one point in his remarks, however, he did refer to patients as beneficiaries. “What if we provide solutions for the whole person, including addressing housing, nutrition and other social needs?” Azar said. “What if we gave organizations more flexibility so they could pay a beneficiary's rent if they were in unstable housing or make sure that a diabetic had access to, and could afford, nutritious food? If that sounds like an exciting idea … I want you to stay tuned to what CMMI is up to.”
More recently, a CMS spokesman said the agency didn't have any additional details regarding who would receive the payments in such a model.