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Table 4 Exemplar quotes for semi-structured interviews

From: Social determinants of health priorities of state Medicaid programs

Topic Exemplar Quote
Data Concerns “Um, so we link our vital records data with our Medicaid data for like low birth weight, and for some other race and ethnicity things we it from our vital records because it’s a better source so that, we do that. We have brought in incarceration data. Incarceration data is actually public data so it’s easy to bring in.”
We are not currently collecting. But we already have databases that include social determinants information. We are in the process right now with our new data warehouse of moving data from various systems all into the data warehouse."
“We did a report … where we took all these indicators for children and compiled them into a report and then did a demographic breakdown by race/ethnicity … so we did a multivariate analysis and we have all this data in that database to look at the relationship of child welfare … or child abuse reporting …
… in terms of the reimbursement system, so ICD9 and CPT and HCPCs coding, having those appropriate modifiers and having them be applied seamlessly as you’re going through an episode of care in the record where the billing and claims occurs at the point of care and then having that go up to the managed care organizations or to fee for service Medicaid and for that data to come through in a seamless manner without additional burden in terms of QI measures or billing coding procedures that are beyond face-to-face eye-to-eye contact with a beneficiary and further delaying and shrinking the opportunity to have a meaningful conversation. Those are all critical issues that we need to do to align that to occur in the interaction between the electronic medical record, the provider, and the patient; the dialog … And if we can collect that data correctly and record that data correctly, the rest will fall into place, including pay for performance.”
… since they all use all of these different tools we don’t actually have a view across the state, even for that top 2% of how many of them actually have housing issues and food instability, because they all ask a different way, the definition of it might actually be different. So, um, our national quality measures stewards need to get their act together, and actually develop measures that have those kinds of specs like the ones we talked about."
Policy Landscape “You know we have under review right now a 1115 waiver proposal that focuses on community engagement requirements which is a particular interest of the federal administration … a large part of that deals with employment and job availability, so in my mind for a lot of our able bodies expansion population that’s one of the SDH to a large degree, is just if you are going to predicate Medicaid vision and dental benefits and just overall eligibility on fulfilling these community engagement requirements that one way I see a clear connection between a major focus of our state’s Medicaid program – a way we can sustain benefits for an expansion population and then getting outside of what’s been really traditionally conceived as a payable service.”
“But I have to recognize that one of the strategies may be well ‘how do we work with this political engine better?’ And you know I have to confess when I was in practice I just was not connected to really how the engine worked. I was always on the receiving end, you know, just trying to do my best in my little neck of the woods and not really look at how much. And now I’m like oh my goodness we need more engaged clinicians to help be part of a better future for everyone … the SDH solution has to have a political arm to it, otherwise it just dies.”
Financial Challenges … I think everybody recognizes or verbalizes an understanding of the social determinants of health are a factor. Um, I would like to be able to put a dollar sign on that factor to go to our budget office and beat them over the head with it (laughs).”
“I think the incentive, we’ve talked about that a little bit but I think the incentive I would like to use it for is to incentivize collaboration between health services, medical services, and social services. And then to get people to address that more solidly. Um, and give a return investment to the community itself. That would be the score and that’s something that we’re, I don’t think we have quite the mechanism to do that yet but that would be the right way to do it.”
"And then the other thing is that we need to also encourage that that gain sharing is encouraged down to the level of the provider and maybe even to the patient. Maybe for doing a good job they get a subway card or a card to- a netflix card. Or whatever. Or a movie card. So we currently have that in our Medicaid expansion program. Those who are successful in doing preventative measures or managing chronic conditions, we provide a reward card to minimize their copays and deductibles.