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New York’s Blueprint for Healthcare: The Rise of Social Care Networks – Part 1
By Salvatore Volpe, M.D., FACS, FAAP, FACP, FHIMSS, ABP-CI, CHCQM
New York is at the forefront of a major shift in healthcare, moving beyond traditional medical services to address the social factors that profoundly impact a person’s well-being. This innovative approach is centered around the development of Social Care Networks (SCNs), a key component of the state’s Health Equity Reform (NYHER) initiative. By creating a collaborative ecosystem of community-based organizations, healthcare providers and managed care plans, New York’s SCNs are working to systematically connect Medicaid members with essential services like housing assistance, nutritious food and transportation.
This blog will explore how these networks are not only improving health outcomes for vulnerable populations but also paving the way for a more integrated, equitable and person-centered healthcare system for all New Yorkers.
Social Determinants of Health
According to the Office of Disease Prevention and Health Promotion, Social Determinants of Health (SDOH) are the conditions in the environments where people are born, live, learn, work, play and worship, including age, that affect a wide range of health, functioning and quality-of-life outcomes and risks. SDOH can impact over 50% of health outcomes which is greater than the impact of medications and traditional health interventions by health care providers and traditional health systems.
Examples of SDOH include:
- Safe housing, transportation, and neighborhoods.
- Education, job opportunities, and income.
- Access to nutritious foods and physical activity opportunities.
- Discrimination and violence.
- Polluted air and water.
- Language and literacy skills.
SDOH also contributes to wide health disparities and inequities. For example, people who do not have access to grocery stores with healthy foods are less likely to have good nutrition. That raises their risk of health conditions like heart disease, diabetes and obesity and can even decrease life expectancy relative to people who do have access to healthy foods.
According to the Federal Healthy People 2030 initiative, just promoting healthy choices will not eliminate these and other health disparities. Instead, public health organizations and their partners in sectors like education, transportation and housing need to take action to improve the conditions in people’s environments.
This is where the Social Care Networks of New York come into play for certain individuals receiving Medicaid.
While SDOH are variables on a community level, health risk social needs (HRSN) reflect the specific gaps experienced on an individual level. Examples include lack of stable or affordable housing, lack of access to healthy food, lack of access to transportation, financial strain and / or unemployment and personal safety.
Social Care Networks
Social Care Networks tie together multiple entities which have not traditionally worked together for many reasons, not the least of which was the lack of an integrated system. This system facilitates performing HRSN surveys, navigating those in need of the appropriate service provider, coordinating the compensation for the services provided and permitting a global view on the impact of the services on the individuals overall health.
SCNs are comprised of HRSN service providers, Medicaid managed care organizations (MCOs), health care providers and other organizations that contract with an SCN Leady Entity and may be reimbursed for services authorized by the 1115 Waiver.
SCN Lead Entities are organizations with expertise in supporting New York Medicaid members, a deep understanding of their region and an ability to coordinate an ecosystem of partners. There are 9 SCN Lead Entities in 11 regions across NYS.
HRSN service providers and organizations that provide services to meet individual needs around food, housing, transportation and other social and / or economic needs. These can include local community-based organizations, non-profit organizations, government entities, health care providers and private sector entities. In New York State, HRSN Service Providers also refers to entities that contract with a SCN to deliver a specific set of services to qualifying Medicaid Managed Care members and may be reimbursed for those services via the New York Health Equity Reform NYHER 1115 Waiver Demonstration.
Health care providers are organizations that provide health care services to individuals including primary care providers, behavioral health providers, Federally Qualified Health Centers (FQHCs), health homes, health systems / hospital systems, etc. Health care providers will be key ecosystem partners in the SCN program, with an objective of better integration of health care and social care through stakeholder convening and a shared data / IT layer.
Enhanced HRSN Services
Enhanced HRSN services are services that help meet members’ HRSN, can improve health outcomes and are reimbursable for qualifying members via SCNs. It is important to note that not all Medicaid recipients qualify for these services. They range in duration from 1-2 weeks to up to 6 months.
Service categories include nutrition, housing, transportation and social care management.
Who Qualifies for Social Care Networks
Medicaid members must meet several requirements to receive enhanced HRSN services. The criteria are as follows:
- A member must demonstrate one or more unmet social need.
- Members must be enrolled in Medicaid Managed Care.
- A member must meet the criteria for one or more of the enhanced service populations.
- They may need to meet additional clinical criteria for a specific service, if required.
- The focus populations are as follows:
- Members with mental health diseases or substance use disorders.
- Members with intellectual or developmental disabilities.
- Pregnant and/or post-partum people.
- Members recently released from prison with chronic health conditions.
- Children under 18 years of age.
- Frequent health care users such as members who often visit the emergency department or with many hospital admissions.
- Members enrolled in a Health Home, a program designed to improve care coordination and management for patients with chronic health conditions and/or mental health needs enrolled in Medicaid.
What is a Health Home:
A Health Home is not a physical location, but a program designed to improve care coordination and management for individuals with chronic health conditions and/or mental health needs enrolled in Medicaid.
In the second part of this blog, we explore the crucial role of healthcare providers in confirming patient eligibility for social care services. We also discuss the key factors providers should consider when incorporating these networks into their practice and look ahead to the future of social care networks in healthcare.
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This document is for general purposes only and should not be construed as medical or legal advice. This document is not comprehensive and does not cover all possible factual circumstances. Because the facts applicable to your situation may vary, or the laws applicable in your jurisdiction may differ, please contact your attorney or other professional advisors for any questions related to legal, medical or professional obligations, the applicable state or federal laws or other professional questions.
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