College of Public Health, University of Kentucky, 111 Washington Ave, 107B, Lexington, KY 40536. Email:
Am J Manag Care. 2023 Mar;29(3):136-141. doi: 10.37765/ajmc.2023.89328.
Many Medicaid managed care organizations (MCOs) now screen enrollees and connect them to community-based organizations (CBOs) to address unmet social needs. COVID-19 has significantly disrupted health care delivery and overall economic activity in the United States. We examined how partnerships between Medicaid MCOs and CBOs to address social determinants of health have been affected by the pandemic.
Guided by questions and recruitment strategies developed with our stakeholder advisory board, we conducted 26 interviews with representatives from all 6 of Kentucky's Medicaid MCOs.
In-depth, structured interviews for data collection and iterative content analyses to identify themes.
Several themes emerged, including substantial increases in enrollees' unmet needs and the demand to find new ways to be responsive, changing funding patterns, disruptions to and evolving modes of communication, and shifting partner relationships. In virtually all areas of impact, COVID-19 has been associated with both negative and positive change.
Unmet social needs associated with the pandemic placed tremendous strain on CBOs, limiting their capacity to sustain some programs and partnerships. Isolation associated with COVID-19 also had wide-ranging effects on service delivery, communication with enrollees and partners, and the ability to maintain relationships. Nonetheless, the pandemic also had some silver linings, including additional resources and flexibility for addressing unmet needs. Federal and state agencies, along with MCO leaders, should carefully evaluate what innovations have been particularly effective during the pandemic and craft new flexibilities into their policies, procedures, and regulations.
许多医疗补助管理式医疗组织（MCO）现在对参保者进行筛查，并将他们与社区组织（CBO）联系起来，以解决未满足的社会需求。COVID-19 在美国严重扰乱了医疗保健服务的提供和整体经济活动。我们研究了 Medicaid MCO 和 CBO 之间为解决健康的社会决定因素而建立的伙伴关系如何受到疫情的影响。
根据与我们的利益相关者顾问委员会共同制定的问题和征聘策略，我们对肯塔基州的 6 家 Medicaid MCO 的代表进行了 26 次访谈。
通过深入、结构化的访谈进行数据收集和迭代内容分析，以确定主题。
出现了几个主题，包括参保者未满足的需求和寻找新的应对方式的需求大幅增加、资金模式的变化、沟通中断和演变模式，以及合作伙伴关系的转变。在几乎所有受影响的领域，COVID-19 都与负面和正面的变化有关。
与大流行相关的未满足的社会需求给 CBO 带来了巨大的压力，限制了它们维持一些项目和伙伴关系的能力。COVID-19 带来的隔离对服务提供、与参保者和合作伙伴的沟通以及维持关系的能力也产生了广泛的影响。尽管如此，大流行也有一些积极的方面，包括解决未满足需求的额外资源和灵活性。联邦和州机构以及 MCO 领导人应仔细评估在疫情期间哪些创新特别有效，并在其政策、程序和法规中制定新的灵活性。
