A combined approach to healthcare includes the management of many health determinants. Some of these are physical health, psychological health, preventative initiatives, as well as social and economic growth (Thornton et al., 2016). While Medicaid heavily revolved around focusing on the first two determinants, the rest, with the social part, in particular, remained neglected. The article by Machledt (2017), titled “Addressing the Social Determinants Through Medicaid Managed Care,” explores the impact of added provisions to address the social determinants of health.
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Summary of Points
The beginning of the article states that managed care ought to be a conjoined effort not only between clinicians, but also economic and social health professionals, in order to achieve improvements for patients on federal, state, and community levels. Machledt (2017) states that the main emphasis of changes for Medicaid should be on tailoring the conditions to the social context of every individual benefitting from the program. The program recognizes that a one-size-fits-all approach is not viable, as different individuals have varied necessities due to their physical and mental capabilities, racial makeup, social standing, and so forth. At the same time, the additions to the program seek to eliminate the convoluted and inefficient expenditures by promoting transparency and value-based managed care.
The first focus of the program is home and community-based services. Medicaid was one of the first programs to recognize that encouraging autonomy, preventive practices, and home-based treatment is more effective than pumping money into the hospital system (Machledt, 2017). To that end, the program seeks to achieve greater community involvement, and assist patients with day-to-day activities, such as pathing, eating, and traveling, on their own. The emphasis is made on choice and patient autonomy, something that could not be entirely achieved in a hospital setting. These goals are congruent with the overarching paradigm of tailoring care to individual social situations.
The second part of the article talks about the reduction of administrative barriers to patients wishing to obtain Medicaid services. One of the oversights of the previous version of the program was that the compensation mechanisms punished health providers for negative outcomes regardless of accounting for patient social and health determinants (Machledt, 2017). It made insurers and hospitals reluctant to address patients whose situation had a higher likelihood of becoming worse. The proposed changes seek to tie reimbursements not only to individual health situations, but also the social factors accounting into it, thus reducing the amount of bureaucratic clout and improving the ease of access.
Finally, care coordination case management seeks to address the social problems of individuals that are likely to exacerbate as a result of their illnesses, or the other way around. Medicaid recognizes that individuals undergoing long-term and intensive treatments are likely to suffer the social consequences of being out of work, being late on their payments, and otherwise not fulfilling their social obligations (Machledt, 2017). Overcoming these issues should be done with the use of CCO (Coordinated Care Organizations), which includes clinical and social support services.
The article recognizes three main challenges to the proposed solutions. The first one includes logistical challenges, as many organizations would need to develop conjoint cooperation plans to address social determinants of health. The second challenge relates to the potential success of the program – a reduction in patient loads would mean less money coming to hospitals and insurers. Finally, Machledt (2017) recognizes that the enacted changes will not completely eliminate the problem, but will be the necessary first step to addressing them.
Social determinants of health are an important aspect of the overall healthcare makeup of populations and communities. The previous version of Medicaid was not properly equipped to address these issues and did not promote enough cooperation between medical and social services. The introduction of managed care rules is not an exhaustive solution, but a necessary improvement from the old model, on the way to a new one.
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Machledt, D. (2017). Addressing the social determinants of health through Medicaid managed care. Web.
Thornton, R. L., Glover, C. M., Cené, C. W., Glik, D. C., Henderson, J. A., & Williams, D. R. (2016). Evaluating strategies for reducing health disparities by addressing the social determinants of health. Health Affairs, 35(8), 1416-1423.