Food, Housing Focus of NQF Medicaid Report About Social Determinants of Health

As state Medicaid programs increasingly turn to waivers and demonstration projects to change service delivery methods, a new report from the National Quality Forum (NQF) outlines a systematic approach to address how to coordinate the unmet health needs of patients in the areas of food and housing—areas that ultimately affect care outcomes.

The guidance for Medicaid programs is targeted at advancing efforts to collect and use data about individuals’ social needs and increase collaboration between communities and healthcare providers to improve beneficiaries’ health.

The report, A Framework for Medicaid Programs to Address Social Determinants of Health: Food Insecurity and Housing Instability, is part of NQF’s multi-year Health Equity Initiative, which seeks to reduce health disparities and advance the delivery of high-quality healthcare for all Americans.

“We know that what really affects health and health outcomes is where and how people live and work,” Shantanu Agrawal, MD, MPhil, NQF’s president and CEO, said in a statement. He said the project “offers Medicaid programs a strategic blueprint to address social needs that affect peoples’ health.”

Social determinants of health (SDOH) are the factors that contribute to a person’s health, such as where they live and work, their housing situation, and their access to healthy food. It’s an issue getting more and more attention from all sectors of healthcare, from payers to health organizations to providers.

However, the NQF noted that the healthcare system does not routinely collect SDOH data or coordinate care to address social needs. Increasingly, Medicaid programs are working to connect health and non-health services. The NQF said that while many Medicaid programs have begun to address SDOH through waivers, demonstration projects, and service delivery reforms, there is no framework for Medicaid programs seeking to make strategic investments in the collection and use of SDOH data.

Work on the report began in July 2017, and in collaboration with CMS, NQF convened an expert panel representing a variety of stakeholder groups—including clinicians, researchers, health plans, health systems, and consumer advocates—to provide strategic guidance to Medicaid programs about collecting and using data about social needs that impact health.

Non-health services that can address social needs include housing and food support, employment services, and home and community-based services. The panel focused on food insecurity and housing instability as key areas for which Medicaid programs can support data collection efforts in the short term, given the growing body of evidence linking food insecurity and housing instability to a negative impact on health outcomes.

The panel specifically recommends that Medicaid programs:

• Acknowledge that Medicaid has a role in addressing social needs that impact health
• Create a comprehensive, accessible, routinely updated list of local community resources for healthcare organizations
• Harmonize tools that assess social needs that impact health to ensure that they collect and document the same type of information
• Create standards for inputting and extracting social needs data from electronic health records to strengthen information sharing between health and non-health providers and programs
• Increase information sharing between government agencies
• Expand the use of waivers and demonstration projects to begin to learn what works best for screening and addressing social needs that impact health.

“This report shares important, practical guidance for healthcare and community stakeholders to work together toward a more holistic approach to improving the health of our nation’s most vulnerable populations,” said Romana Hasnain-Wynia, PhD, MS, chief research officer, Denver Health, and chair of the NQF expert panel.

Andrew Anderson, senior director, NQF, who was the staff lead on the project, said the report is “guidance for Medicaid programs to work with health care and community stakeholders as well as other government agencies to improve the quality and efficiency of care for patients and families with the greatest need.”