Dr. Karishma S Chhabria

The 2022-23 General Appropriations Act (GAA), House Bill (H.B.) 1, 87th Legislature, Regular Session, 2021 (Article IX, Section 10.06) authorizes the Cross-Agency Coordination on Healthcare Strategies and Measures project. This project, referred to as “The 5 Agencies Project,” requires state agencies that pay for the health care of Texans to coordinate data to identify outliers and improvements for efficiency and quality that can be implemented within each health care system.
This report summarizes actions taken since the initial report to the Legislative Budget Board (LBB) and Office of the Governor, submitted on September 1, 2020. It includes the activities and outcomes during the second year of the initial two-year project period (initial biennium: fiscal year 2020–2021), as well as the first year of the renewed project cycle (renewed biennium: fiscal year 2022–2023).

This Assessment of Social Factors impacting Health Care Quality in Texas Medicaid deliverable fulfills one of the eight milestones included in the Delivery System Reform Incentive Payment (DSRIP) Transition Plan, which explains how the Texas Health and Human Services Commission (HHSC) will further develop delivery system reform efforts in Texas Medicaid without DSRIP funding. The objective of this milestone is to assess which social factors may be correlated with health outcomes for beneficiaries enrolled in Texas Medicaid as well as help inform possible new program proposals, policy changes, and strategies for quality improvement related to social determinants of health (SDOH).

The 2020-21 General Appropriations Act, House Bill 1, 86th Legislature, Regular Session, 2019 (Article II, Health and Human Services Commission [HHSC], Rider 33) requires HHSC to evaluate variation in service delivery to individuals with serious mental illness (SMI) by managed care organization (MCO). Rider 33 also requires HHSC to identify performance measures to better hold MCOs accountable for outcomes and spending for individuals with SMI, evaluate the delivery of services, and develop recommendations to improve quality of care.
STAR+PLUS serves adults with disabilities and individuals who are 65 years or older. For the report, Medicaid STAR+PLUS members were evaluated. Dually enrolled members were not included because data was not available.
Claim-based performance metrics were evaluated to develop the report. The claimbased data, which include managed care encounter data, have several strengths including clinical validity, a representative population, and access. However, like any data set, there are limitations. The claims are based on the record of care received. Furthermore, the data provide no detail on the severity or longevity of the diagnosed condition, which may impact behavioral health (BH) outcomes. Readers should consider these limitations when drawing any conclusions from the findings.

The Texas Health and Human Services Commission (HHSC) administers Medicaid health benefits to approximately 4.3 million individuals. Due to increasing interest regarding the impact of social determinants of health (SDOH) on Medicaid health outcomes, this study evaluated the presence of significant associations between a comprehensive set of SDOH variables and key health care quality measures for (1) the Texas Medicaid and Children’s Health Insurance Program (CHIP) population under age 19 in 2018 and (2) the Texas Medicaid pregnant women population in 2018. Additionally, this study estimated the degree (as a percentage) to which individual SDOH variables contributed to the collective SDOH impact by analyzing the statistically significant associations between individual SDOH variables and the performance outcomes of each quality measure per study population.