Working with Community Care Hubs to Address Social Drivers of Health: A Playbook for State Medicaid Agencies

Prepared by Manatt Health in collaboration with the Partnership and with support from The SCAN Foundation, this publication is a one-of-a-kind resource for state Medicaid agencies seeking to partner with CBO networks and Community Care Hubs in the design and implementation of SDOH initiatives.

Research demonstrates personal behaviors, physical environments and socioeconomic factors—commonly referred to as the social drivers of health (SDOH)—are responsible for 80 percent of health outcomes. Individuals enrolled in Medicaid experience disproportionate rates of complex health and social needs.

As state Medicaid agencies are increasingly looking beyond the health care system for solutions to improve health outcomes and achieve value, the Playbook aims to: 

  • Identify opportunities for state Medicaid agencies to partner with networks of community-based organizations (CBOs) and Community Care Hubs (CCHs) to address SDOH;
  • Introduce state Medicaid leaders to the key functions of CCHs, and provide practical advice on how state Medicaid agencies can collaborate with CCHs;
  • Highlight strategies to overcome existing challenges around establishing and building sustainable relationships between CBOs and health care organizations; and
  • Feature practical examples, tips and links to materials used to support SDOH and CCH efforts
    in communities across the country.

Working with Community Care Hubs to Address Social Drivers of Health: A Playbook for State Medicaid Agencies