The New York Medicaid 1115 Waiver is transforming how Medicaid beneficiaries receive care by integrating social determinants of health (SDOH) into the healthcare delivery system. By addressing social factors like housing, food security, and access to transportation, the program is creating a more holistic and effective approach to healthcare. In this blog, we’ll explore how the waiver works, the impact it has on healthcare providers, and how innovative tools can help providers navigate this new landscape of care.
What is the New York Medicaid 1115 Waiver?
The 1115 Waiver, a demonstration program authorized by the Centers for Medicare & Medicaid Services (CMS), allows states to test new Medicaid delivery systems. New York’s 1115 Waiver focuses on integrating social needs into healthcare, recognizing that a person’s living conditions, access to food, and other socioeconomic factors significantly impact their health. The program promotes a shift from traditional medical care to a broader focus on prevention, care coordination, and community-based interventions.
This waiver provides New York with the flexibility to try innovative models of care that can potentially lead to better health outcomes while addressing systemic health disparities. A major part of the initiative is the creation of Social Care Networks (SCN), which connect healthcare providers with local organizations to meet the non-clinical needs of patients.
By expanding the scope of care to include SDOH, the 1115 Waiver ensures that Medicaid beneficiaries receive comprehensive, patient-centered care that focuses not just on treating medical conditions, but on improving the overall well-being of individuals and communities.
Key Features of the New York Medicaid 1115 Waiver
Incorporating Social Determinants of Health (SDOH)
The heart of the 1115 Waiver is its emphasis on SDOH. Traditional healthcare models have largely focused on treating diseases or conditions once they manifest. However, the waiver takes a proactive approach, identifying and addressing the social barriers that contribute to poor health outcomes in the first place. For example, housing instability, food insecurity, and limited access to transportation can all significantly affect a person’s ability to manage chronic conditions or receive timely medical care.
By addressing these factors early on, providers can reduce the need for emergency room visits or hospitalizations, ultimately improving the long-term health of patients and decreasing healthcare costs.
Social Care Networks (SCN)
The SCN plays a vital role in connecting patients to essential resources that meet their non-medical needs. This network includes local community organizations, shelters, food banks, transportation services, and more. Through SCNs, healthcare providers can access a directory of local resources to help address specific needs for their patients.
These partnerships are vital in addressing gaps in healthcare services that are rooted in social inequalities. Providers using the SCN can ensure that they are not just treating symptoms but addressing the underlying causes of health problems by linking patients to the right social support services.
Value-Based Payments (VBP)
The waiver continues the nationwide shift toward value-based payment models. Under this framework, healthcare providers are reimbursed based on the quality of care they provide rather than the volume of services rendered. This incentivizes providers to focus on patient outcomes and preventive care, which can help reduce long-term costs.
By aligning financial incentives with quality care, the 1115 Waiver promotes a more efficient system that benefits both healthcare providers and patients. Providers can earn higher reimbursements by improving care coordination, managing chronic diseases effectively, and addressing the full spectrum of patient needs, including SDOH.
Improved Care Coordination Across Systems
Coordination among medical, behavioral, and social service providers is at the core of the waiver. Healthcare providers are encouraged to work together across sectors to create comprehensive care plans for patients. By considering medical, behavioral, and social factors in tandem, this approach reduces fragmented care and ensures that all aspects of a patient’s health are addressed. This comprehensive care model is designed to improve health outcomes, reduce hospital readmissions, and provide more personalized care for patients.
The Benefits of the NY 1115 Waiver for Healthcare Providers
Improved Patient Outcomes
By addressing social needs alongside medical care, providers can improve the overall well-being of their patients. Research has shown that when SDOH are effectively addressed, patients experience fewer complications, fewer hospital readmissions, and greater overall satisfaction with their care. This comprehensive approach leads to healthier communities and more successful health outcomes.
Cost Savings
Addressing social needs early can help prevent costly emergency room visits and hospitalizations. By working to eliminate the underlying causes of health problems—such as housing insecurity or lack of access to healthy food—providers can reduce long-term healthcare costs and promote greater efficiency within the healthcare system.
Increased Reimbursement Opportunities
Providers participating in the 1115 Waiver have the opportunity to earn higher reimbursement by providing screening and navigation services. They can also benefit from the increase in PMCH rates in NYS. The shift to value-based payments means that providers who demonstrate success in addressing both medical and social needs can benefit from enhanced reimbursement.
Stronger Community Relationships
The 1115 Waiver encourages healthcare providers to collaborate with local organizations to address the broader needs of their patients. These partnerships strengthen ties between healthcare systems and community organizations, helping to create a more cohesive support network for patients. This collaborative approach ensures that all aspects of a patient’s health are considered, leading to improved care delivery.
Enhanced Health Equity
By focusing on underserved populations and addressing disparities in care, the waiver supports the state’s goal of improving health equity. Programs like SCN ensure that vulnerable groups receive the care and resources they need, breaking down barriers to access and promoting fairness across the healthcare system.
Supporting Providers with the Social Care Hub
To help providers streamline processes and meet the requirements of the 1115 Waiver, MDLand is launching its Social Care Hub in iClinic® EHR. This tool will help providers screen for social needs, connect patients with community resources, and track outcomes for value-based reimbursement.
The Social Care Hub is coming soon to support practices in closing care gaps and improving patient outcomes while aligning with Medicaid reform goals.
MDLand is deeply committed to addressing health equity by empowering providers to close care gaps and improve patient outcomes.
Stay ahead of Medicaid reform with the Social Care Hub—coming soon! Learn more about SCNs here.
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