Moving Upstream Report by Episcopal Health Foundation Seeks to Affect Legislation

A 2022 key report developed and published by the Episcopal Health Foundation (EHF) and the Center for Health Care Strategies speaks to the merits of nonmedical programs which could be supported by Medicaid in Texas. Investment in nonmedical programs could reduce ER visits, sick days, and Medicaid costs, according to the report.

Nonmedical programs studied are those that work to address three areas—asthma home remediation, food as medicine, and support services for housing programs.

The report will now be used to urge state lawmakers to expand “upstream” Medicaid programs to cover nonmedical drivers of health. Those drivers include the conditions in which people live, work, play, and age—factors that influence health and wellness.

“Medical care makes up about 20 percent of what determines a person’s health, yet right now we spend almost all health dollars—including Medicaid—treating medical conditions, and not preventing disease outside the exam room,” CEO of EHF Dr. Ann Barnes said. “We have to change the way we think about health and how we pay for it. “The report shows how things could change for the better in Texas.”

One example in the study focuses on an asthma remediation program which identified mold as an asthma trigger in the home of a girl, age 12. As moldy carpet was removed, the child’s attacks lessened significantly.

Centers for Disease Control reviewed asthma remediation projects across the country, showing for every $1 invested, non-medical programs save from $5-$14. Further evidence from Medicaid programs across the country show programs outside doctors’ offices resulting in improved health outcomes for Medicaid enrollees equate to increased financial savings.

Researchers also found nonmedical programs to reduce Medicaid spending on medical care by an average $220 a month per person.

In addition to benefiting Medicaid costs, the report outlines specific ways the Texas Health and Human Services and Medicaid-managed care organizations could implement the interventions.

“This is a game changer that could improve the health and wellness of Texans most in need in an entirely new way,” said Barnes, who is also a physician.

The report will be used to make recommendations to state lawmakers by the Texas Value-Based Payment and Quality Improvement Advisory Committee. The committee is a forum of Texas Health and Human Services.