If you're interested in public health policy and are seeking ways to move ACEs prevention / intervention upstream - check out this [open source] article - shared by Medical-Legal Partnership.
Article: "Expanding Upstream Interventions with Federal Matching Funds and Social-Impact Investments"
Open Source Solutions, By Steven H. Goldberg, Paula M. Lantz, and Samantha Iovan
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This paper explores trends driving Medicaid’s efforts to “shift from volume to value” and the implications for federal payment of non-clinical services. It concludes that the Final Rule allows federal Medicaid funds to support outcomes-based spending on non-medical interventions and programs, and that future rate reductions are unlikely to offset potential cost savings from reduced demand for medical care over a multi-year planning period. The regulations modernize incentives for states and MCOs to expand the availability of SDOH-related programs that might improve population health outcomes at a lower total cost of care.
Copied from the linked article:
... Outcomes-based funding might help accelerate the adoption of interventions that address social circumstances and other non-medical factors to an extent that has so far eluded federal and state efforts. Private investors would provide the up-front funding for the expansion of prevention, early intervention, and other social programs. In the case of interventions that attempt to address health-related social factors, investors would get their money back with a financial return only if, when, and to the extent that the interventions reach or exceed agreed-upon outcome metrics. These could include reduced use of health care services, health-risk behavior change, and social metrics like housing stability, educational attainment and reduced recidivism, as well as cost savings.
In addition to the growth in the size and cost of the Medicaid program, there is a growing recognition that the social determinants of health—pervasive influences such as economic instability, inadequate housing and education, poor nutrition, and other environmental and community factors—have decisive impacts on health status over the life course.11 The Final Rule encourages Manged Care Organizations (MCOs) to shift federal and state payments from “downstream” health care treatment after people become ill to “upstream” social services and prevention efforts (at both the individual and community level) that might keep beneficiaries healthy at lower cost.
Both trends are moving away from the previous Medicaid regulatory framework, which off-loaded much of the financial risk of furnishing health care for poor and low income people from government agencies to private and nonprofit health insurance plans (Plans) and clinical care providers (Providers). Those rules generally discouraged Medicaid MCOs from spending health care dollars on programs and services from non-clinical providers that address non-medical factors such as food insecurity and housing instability.
Some market leaders are beginning to turn their attention to this systematic misallocation of resources. Kaiser Permanente recently announced a $200 million impact investment in permanent housing for chronically homeless individuals 12 following a $20 million commitment by United Healthcare in 2016. 13 On August 21, 2018, a national network of 17 large hospital systems (comprising 280 hospitals) led by AVIA launched the Medicaid Transformation Project “to identify, develop, implement and scale financially sustainable solutions that improve the health of underserved individuals and families in their communities.”14...
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“[d]isparities and social determinants of health that contribute to patient complexity and disease severity would be appropriate considerations in developing the risk adjustment methodology” under the “rate development standards” in §438.5. Fed. Reg. 27577
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