4 evidence-based interventions you should be addressing

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Medicaid has both cost and outcome problems. It is now the largest insurer in the nation, with a price tag of $604 billion in 2019. Unfortunately, higher spending isn’t creating better outcomes. The U.S. spends more on health care than any other country. Yet, compared to its peers, it underperforms on key health indicators, including life expectancy, chronic disease handling, and maternal and infant mortality rates.  

The answer, according to CMS, is a shift toward value-based care to address social determinants of health (SDOH). A critical part of this is evidence-based interventions. 

Determining the connection between SDOH and health outcomes isn’t a simple task. It requires a great deal of data and analysis. Additionally, some SDOHs aren’t easily discernible, especially those attributed to behaviors and social circumstances. That’s the initial challenge. 

Next is developing strategies to address them. When those are evidence-based—meaning they’ve been evaluated and found to be effective—you will be able to tackle the cost and outcome conundrums. 

So what are the latest innovations in evidence-based interventions for Medicaid members? Here are some ideas to consider:

Integrating all aspects of health for high-need, high-cost populations

A young african american woman talks to a male doctor about loneliness.

It isn’t just the care that is expensive for high-need members. Other factors cause these people to be at elevated risk for chronic diseases, and they will often fail to seek proactive treatment.  

When you identify these members, adjusting your care approach can be helpful. One way to do this is with home- and community-based services (HCBS). When high-need members participate in HCBS, it improves their self-care, medication adherence, and management of chronic diseases.  

Plans should leverage their data, identify high-need members, assess how HCBS can help them, and determine what waivers could pay for their care. 

Applying evidence-based practices for Substance Abuse Disorders

Substance abuse is a considerable challenge in care delivery and has devastating consequences. Medicaid plans can take an active role in assessing a member’s substance abuse disorder (SUD) and clinical guidance for medication-assisted treatment (MAT). MAT combines behavioral therapy and medications to treat SUDs. This approach is effective for treating opiate use disorder (OUD) and reducing death rates.

To increase the use of MAT, evidence-based strategies should:

  • Include all medications that treat OUDs on the state preferred list, which requires a collective effort between plans and states. 
  • Provide educational resources to members living with OUD so that they understand their options. 
  • Reduce non-quantitative utilization management restrictions, such as prior authorization and blanket limits. (Many states have these to prevent “diversion,” which is the sale of prescription drugs to others. However, research shows diversion is typically for treatment, not abuse.)
  • Ensure there is a sufficient network of MAT providers, which may be the most difficult intervention practice. You can use data to find areas without access to MAT providers. One way to expand access is to incentivize hospitals to facilitate MAT induction.

Learn the 10 Things to Evaluate Before Choosing a Member Engagement Solution  for Your Plan.

Using evidence-based interventions to help with unhealthy behaviors

If members engage in behaviors that negatively impact their health, you want to intervene. There are two specific areas with evidence-based strategies plans can use—tobacco cessation and the prevention of unintended pregnancies. These come from the CDC’s 6 | 18 Initiative

To reduce the use of tobacco:

  • Ensure members have access to FDA-approved cessation medications and treatments in individual, group, or telehealth settings.
  • Remove barriers around payment for programs through cost-sharing or prior authorization.
  • Promote increased use of covered treatments for tobacco users.

With this three-pronged approach, your plan can help members stop using tobacco. As a result, they will be healthier and have a decreased chance of complications due to tobacco use. By investing in evidence-based interventions, you save money on treating ailments caused by tobacco.

The other topic is preventing unintended pregnancies. The 6 | 18 strategy recommends improved contraceptive access, specifically long-acting reversible contraception (LARC). A study of a Colorado clinic found that offering methods on a sliding-fee scale increased the usage of LARC from 5 to 19 percent in those aged 15-24. In five years, the program reduced unintended pregnancy rates by 40 percent for teens and 20 percent for women 20-24. 

The evidence-based strategies to prevent unintended pregnancies include reimbursing providers for all FDA-approved contraceptives and associated services. Additionally, plans should remove administrative and logistical barriers to receiving these services.

Technology and human touch drive innovation in addressing loneliness

Research on loneliness tells us that it’s a factor in care outcomes. If a Medicaid member suffers from loneliness, they will be less engaged in their care. This disengagement may cause them to not adhere to their medication or treatment regimens. They will also be more likely to be readmitted to the hospital. 

Evidence-based interventions for loneliness do exist! The Pyx Health platform focuses on helping vulnerable members experiencing loneliness and social isolation. It combines technology and human connection. 

Members have access to an app, where they can complete screening questions to identify SDOH challenges and determine loneliness risk factors. They can also go through this evaluation with our trained, certified, and compassionate team. 

Based on the information, we close the gaps around treatment for chronic loneliness and connect your members to programs that can improve their physical and mental health. Throughout their time in the program, they can talk to our staff without limits or judgment. 

These interactions and support services help members find their way to healthier habits and practices and feel more engaged with the world. 

Want to learn more about why this program is critical for evidence-based care strategies? Schedule your demo today.

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