New alliance negotiates with health plans to address the social determinants of health

In an effort called the first of its kind, an independent practice association in upstate New York is negotiating with health plans and using IT to connect Medicaid members to organizations that address the social determinants of health.

The health plan MVP Health Care, a managed care organization, pays the Healthy Alliance Independent Practice Association (IPA), which then matches the funds and pays the community service organizations, such as food pantries. 

The MCO's Medicaid members are enrolled in the IPA to have their care coordinated across a large network of regional social service providers such as homeless shelters and food banks, as well as traditional medical providers.

Providers are connected to social service organizations through Unite Us, a technology platform that digitally connects the two sectors for referrals and tracking purposes.

The partnership launched in upstate New York last month and currently has one health plan involved, but two more are expected to be announced soon, said Dr. Jacob Reider, CEO and founding member of the Alliance for Better Health and former deputy director of the ONC under President Obama.
The Alliance for Better Health formed the IPA to provide an organizational structure to contract with a health plan on behalf of the current 31 community service organizations that are part of the IPA.

An estimated $800,000 is being distributed to these select nonprofit organizations in six counties in the capitol region of New York.

WHY THIS MATTERS

Healthy Alliance is the first IPA in upstate New York to focus exclusively on addressing the social determinants of health, Reider said.

The IPA structure serves as a central point of contact to connect medical providers, community organizations, accountable care organizations, and managed care organizations with high-need individuals who need services such as housing, nutrition, and transportation.

While too soon to track results, the results are expected to improve the health of the community and reduce total cost of care.
 
Kaiser and CVS are two other organizations using the Unite Us platform, launching multi-million-dollar initiatives to address social determinants of health, according to Reider.

THE LARGER TREND

Historically, community organizations have relied on grant funding from states, foundations and charities to fulfill their mission, but Reider believes this model will change in the next three to five years, creating a need for non-profits to find new and lasting funding streams.

Physicians are currently challenged to connect their patients to needed services. There's also no way for them to determine if a patient has gotten the needed services.

Unite Us closes that loop, validating when a patient is referred, Reider said.  Doctors log into Unite Us software for the appropriate referrals and can see the results.

"Through this technical framework, we created an administrative framework," Reider said. "We don't know of any other in the country."

Phase I is to demonstrate the total cost of care is reduced and the health plan realizes a return on investment. The expectation is that in the future, health plans will take on more of the cost.

ON THE RECORD

"At MVP, we understand the important role that social factors can have on a person's overall health and how those influences can effect short and long-term outcomes," said MVP Health Care's President, Christopher Del Vecchio. "Investing in the underlying social, economic, and environmental factors that contribute to an individual's health, reinforces our commitment not only to the overall health and wellness of our members, but to the entire Capital Region community."

"What's unique here is the IPA, to negotiate with health plans," Reider said. "Addressing social determinants of health, or the conditions in which people are born, live, grow, work, and age, has a substantial impact on a person's health."

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com