Valuing the Recovery Priorities of Orthopaedic Trauma Patients After Injury: Evidence From a Discrete Choice Experiment Within 6 Weeks of Injury

Abstract

ISSUE: It is widely recognized that social factors, such as unstable housing and lack of healthy food, have a substantial impact on health outcomes and spending, particularly with respect to lower-income populations. For Medicaid, now dominated by managed care, this raises the question of how states can establish managed care rates to sustain investments in social supports. GOAL: To explore practical strategies that states can deploy to support Medicaid managed care plans and their network providers in addressing social issues. METHODS: Literature review, interviews with stakeholders, and analysis of federal regulations. FINDINGS AND CONCLUSIONS: We identify the following options: 1) classify certain social services as covered benefits under the state's Medicaid plan; 2) explore the additional flexibility afforded states through Section 1115 waivers; 3) use value-based payments to support provider investment in social interventions; 4) use incentives and withholds to encourage plan investment in social interventions; 5) integrate efforts to address social issues into quality improvement activities; and 6) reward plans through higher rates for effective investments in social interventions. More needs to be done, however, to assist interested states in using these options and identifying pathways to braid Medicaid dollars with other social services funding. KEY TAKEAWAYS Social factors like unstable housing and lack of healthy food are widely known to affect health care outcomes and spending. While Medicaid traditionally has not covered or reimbursed for social interventions, it offers more practical options for doing so than is commonly recognized. With the predominance of Medicaid managed care, states require new contract and ratesetting strategies to enable plan and provider investment in social interventions. Options available to address social drivers of health include: classifying certain social services as covered Medicaid benefits, using value-based payments to support provider investment in social interventions, and rewarding managed care plans with higher payment rates.

Patients Place More of an Emphasis on Physical Recovery Than Return to Work or Financial Recovery

“…However, it is impossible to align services and resources for optimal use without first establishing patients’ priorities for physical, work-related, and financial recovery. The findings of this study substantially expand upon our prior publication providing clinicians, policy makers, and the research community a nuanced understanding of the variation in patients’ recovery priorities within 1 year of injury [21]. We observed patients’ concern for physical recovery exceeds their concern for work-related recovery and access to disability benefits in the year after injury.…”

“…Many other recovery domains were not included in the discrete choice experiment. However, we believe we included the most relevant priorities because our selection process was informed by focus groups and semistructured interviews with clinicians and patients who sustained a fracture [21]. Although the recovery priorities may be correlated [29], the discrete choice experiment is an effective method to disentangle the independent effects of correlated outcomes.…”

“…Otherwise, the survey was sent to the patient by email and completed in the Research Electronic Data Capture (REDCap) survey platform (Nashville, TN, USA) (Appendix 2; Supplemental Digital Content 2, http://links.lww.com/CORR/A483). Details on the development of the attributes and attribute levels for the study have been described [21].…”

“…All patients were recruited for participation between June 2018 and December 2018 from a single Level 1 trauma center in Maryland. The 6-week survey data reported in this study have been previously published [21]. The prior publication was considered pilot and feasibility work.…”

“…lww.com/CORR/A483). Details on the development of the attributes and attribute levels for the study have been described [21].…”