Non-Medical Drivers of Health (NMDOH) Strategies: Findings from a 2022 Survey of Managed Care Organizations (MCOs) in Texas

In late 2018, the Episcopal Health Foundation (EHF) partnered with the Texas Association of Health Plans (TAHP) and the Texas Association of Community Health Plans (TACHP) to conduct the first ever Texas survey to capture Medicaid health plans activities to address non-medical drivers of health care (NMDOH). The survey highlighted that while Texas Medicaid managed care organizations (MCOs) are committed to addressing NMDOH there are challenges in financing, incentivizing and sustaining non-medical interventions. The survey responses also highlighted that there is a lack of understanding of Texas Medicaid policies and regulations that authorize MCOs to advance NMDOH activities. The survey findings were also published in a Health Affairs blog article in the summer of 2019. As a result of this collaborative effort, EHF, TAHP, TACHP and Texas Health and Human Services (HHSC) partnered to form the Texas MCO NMDOH Learning Collaborative.

In 2020, EHF, in partnership with TAHP and TACHP, initiated a second MCO NMDOH survey that focused on identifying MCO strategies to address NMDOH during the COVID-19 pandemic. This survey focused on questions around the following domains; MCO screening and referral practices, NMDOH services offered by MCOs, COVID implications of MCO work, MCO telehealth strategies, challenges and facilitating factors in NMDOH investment, and barriers and technical assistance needs expressed by MCOs. The survey highlighted that during the COVID-19 pandemic, MCOs saw an increased need to address NMDOH and MCOs also observed that many community-based organizations (CBOs) were overwhelmed with increased social service needs but were short on funding resources.

The Learning Collaborative entered its’ fourth year in January 2023. Year four will focus on infrastructure to advance initiatives and reimbursement of activities to address NMDOH and ensure that the MCOs, providers and HHSC have the infrastructure in place to make NMDOH initiatives successful and ensure outcomes are measurable. The 88th Legislature is currently convening and if legislation is passed, it is important now, more than ever, to ensure that infrastructure is in place to ensure NMDOH pilots, programs and initiatives are operational.

To support the year four work plan, a third Medicaid health plan NMDOH survey was launched in December 2022. The goals of this survey are to better understand the challenges and opportunities of addressing Medicaid Members’ NMDOH needs, identify the infrastructure needs to support NMDOH investment and initiatives, understand barriers to health plan NMDOH investment, and identify potential policy changes needed to incentivize health plan NMDOH investment.

Treaty Oak Strategies conducted an online survey from December 6, 2022, to January 21, 2023, via SurveyMonkey™. Fourteen of the sixteen contracted Texas MCOs, responded to the survey, reflecting an 87.5% response rate. This report outlines the survey findings in the following domains: MCO NMDOH screening and referral practices, data sharing, APM infrastructure, and current investments. This report also offers takeaways for consideration, including a comparison of the three MCO NMDOH surveys.

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