We launched the new year with some promising news for the Upstream Movement. On Jan. 4, the Centers for Medicare and Medicaid Services (CMS) released new guidance outlining how states can use “in lieu of services and settings” (ILOS) funds to address patients’ health-related social needs. In other words, CMS clarified that states can use this authority to expand access to services to address social needs such as housing instability or food insecurity.
This latest set of CMS guidance is one of several significant opportunities for integrating health and social care that have emerged in the past year, from both government agencies and private accreditors. It follows on the heels of a December all-state call where CMS explained the opportunity to address health-related social needs through 1115 waivers. In the last year, CMS has approved a number of state plan amendments, 1915(c) waivers, managed care ILOS, and 1115 demonstration waivers that incorporate robust social needs strategies. These efforts echo recent developments in the private realm, such as the Joint Commission’s new accreditation requirements, which require hospitals to identify and address health disparities.
This series of developments is no coincidence. It represents a growing drumbeat of progress—with each new policy a step toward integrating health care within a broader, multisector mission to advance health equity.
In addition to what the new guidance symbolizes, it creates clear pathways for states—along with the Medicaid managed care plans they contract—to take action. When new policies like these come, they open space for vanguards to innovate and scale solutions to expand access to social services, address patients’ health-related social needs, and help counteract deeper structural drivers of health inequities. In the case of the latest CMS guidance, states that want to address social needs now know how they can use ILOS approaches to provide these services as alternative benefits. In realms where only the boldest trailblazers were previously pushing the boundaries, there is now space for many others, too, to move upstream.
A critical question now is: HOW will Upstreamist leaders do this—and how will they do so with an equity lens? Leaders on the front lines and in Medicaid managed care plans still need help to identify how to use this opportunity to expand social needs interventions and connect those interventions to the work of advancing equity. They mustn’t miss the equity part—because as we’ve learned, trying to move upstream without an equity focus results in doing so unsuccessfully. When done well, linking social care integration with equity unlocks the potential of both efforts to drive meaningful change for the people we care for.
There are more opportunities now than ever to do this. And equipping ourselves to meet (and even exceed) the spirit of these evolving standards is the challenge of this new year.
As we begin 2023, HealthBegins is uniquely prepared to help Upstreamists meet this moment. We understand the deep relationships between health equity, social needs, and social determinants—and the practical strategies for driving meaningful change across all those issues at once. We’re excited to see how bold leaders will put solutions like Community Health Detailing to work to reduce inequities, and how HealthBegins’ forthcoming programs and educational resources for leaders in Medicaid managed care plans and primary care practices will help those closest to the ground address social drivers of ill health.
Through it all, we’re also determined to work with you, our upstream community of practice, to inform policymakers about our work on the ground and influence regulators to create more opportunities and make even more progress—in areas where the existing policies still fall short.
Happy New Year! Let’s get started.
Rishi Manchanda, MD, MPH. Sadena Thevarajah, JD