September 09, 2019 – Optima Health’s Traci Massie can outline the different social determinants of health that impact Virginia’s different Medicaid populations county by county, from the opioid epidemic to food security.
Norfolk, for example, has the highest rate of infant mortality, the director of government programs at Optima said. Southwestern counties often face high rates of obesity.
“You have to understand your population, and within the state of Virginia, within those regions, they’re not all the same,” Massie told HealthPayerIntelligence.com. “It’s not a one size fits all.”
But there is one social determinant of health that is fairly common across Medicaid populations: food insecurity.
According to America’s Health Rankings, the percentage of Virginians facing food insecurity between 2015 and 2018 hovered around 9.5 to 10.1 percent. Given the well-known health impacts food insecurity can have, Massie and her team knew they needed to create a food assistance program that could target this broad demographic.
Optima Health first looked for a partner that offered discounts not just on canned and frozen foods, but on fresh, healthy produce. The payer also sought to provide Medicaid members with more than just lower food costs, but also over-the-counter items such as baby care or cleaning products.
Collaborating with Solutran’s Healthy Savings program, Optima Health outlined a plan to lower the healthy food cost barrier for Medicaid beneficiaries across the state and improve health conditions overall.
“We’re going to play a role in how you get that healthy food so that you can be compliant to help your medical condition,” Massie said.
When the state sends Optima Health’s monthly Medicaid enrollment file, the payer immediately mails a discount card to new members with an explanation of the Healthy Savings program.
When the member goes to a participating grocery store, such as Food Lion, Kroger, or Giant, she can scan her Healthy Savings card at the checkout to apply her savings.
If she has a coupon that she wants to use, the Health Savings discount is stackable, meaning that other coupons still apply to the discounted item.
As the first batch of Optima Health’s Healthy Savings cards are delivered in September, Massie has two goals for the Healthy Savings program.
First, she anticipates that members will begin to make healthier choices in the grocery store as more healthy options come within reach financially. Data shows that this goal is feasible, with recent studies suggesting beneficiaries purchase more fresh produce when they receive discounts on fruits and veggies.
Second, Massie expects to see an impact in members’ overall health by delaying or ending the progression of chronic diseases and preventing the development of other medical conditions, all the result of healthier eating. The correlation between food insecurity and chronic diseases could foretell significant improvements in members’ chronic disease management if the program is successful.
However, these impacts can only be realized if members use the card effectively.
To ensure that members are aware of the program, the payer is launching a traditional marketing campaign through email and mailings. Optima Health is also triangulating its marketing with other Optima Health programs, such as its events for pregnant women and an educational program which will launch at the end of the year.
The payer, which hosts baby showers for its pregnant members as part of its benefits packages, will use that event to remind the moms to get their prenatal visit and also to use their Healthy Savings card for baby products and other healthcare or food items.
Members will also hear about the program through Optima Health’s eight-class Health Education and Literacy Program (HEAL), to be launched in collaboration with the College of William & Mary and Literacy For Life at the end of the fourth quarter. The classes will occur one night a week in all six regions of the state.
The healthy eating module will encourage attendees to use their Healthy Savings card to make healthy choices in the grocery store.
The classes can be taken together or independently and aim to teach the Medicaid community about key factors in healthcare literacy. Other modules will cover subjects such as emergency room usage, how to read a prescription bottle, and questions to ask or conversations to have with a primary care provider.
To Massie, Medicaid is just the start. She hopes to extend the Healthy Savings card to all Optima Health members.
Massie expressed optimism about the industry’s direction in terms of payers taking responsibility for social determinants of health.
“In the beginning, payers may not have necessarily embraced that it was our responsibility to actually provide the actual programs and services themselves because it wasn’t our core competency,” Massie said. “Now, we realize that there is a place for us in that space and that we actually should be there. We are the closest to the members, and so it is our responsibility to be there, and I’m delighted that more and more payers are embracing it.”
Despite her positivity, challenges may be in store for the Medicaid populations at Optima Health and across the nation due to recent proposed changes to federal poverty level calculations.
Virginians on the state’s newly expanded Medicaid program may lose their access to food stamps if the administration’s proposed changes to the inflation adjustment are finalized. The proposal suggests using the Chained Consumer Price Index for All Urban Consumers, or chained CPI, to alter how the inflation rate affects the federal poverty level (FPL).
These changes would influence eligibility for many government programs including Supplemental Nutrition Assistance Program (SNAP).
According to a retrospective analysis from the Urban Institute, if the proposed changes had taken place in the fifteen years prior to 2016, the FPL would have decreased and, in Virginia, 6,000 fewer SNAP households would have been eligible for SNAP assistance in 2016.
As policymakers continue to redefine the industry’s legal parameters and structure, payers can continue to step into the gap to provide social determinants of health support to Medicaid beneficiaries who may feel caught in the middle.
“Whether it’s in food insecurity, whether it’s in transportation, housing, employment—all those types of things affect the members and we want to be holistic in the way we approach them here at Optima Health, how we handle our members, because we’re walking hand in hand with them,” Massie said.