Reimbursement for Evidence-Based Health Promotion Programs in the Community

Sarah Barth
Sarina Coates-Golden
September 2020

Evidence-based health promotion and disease prevention programs (evidence-based programs or EBPs) include programs by Medicaid, Medicare Advantage, and other health plans on chronic disease self-management education and falls prevention. This brief explores: (1) state financing mechanisms for EBPs; (2) promising practices to support replication and sustainability of EBPs; (3) barriers to adopting EBPs; and (4) steps to address these barriers and strengthen relationships with state Medicaid programs or other insurance markets. It also provides practical examples of programs and funding structures.

Some successful approaches focus on building strong cross-sector relationships and communication across states, health plans, and community-based organizations (CBOs), positioning CBOs as key community resources, and leveraging grant funding along with state interests and resources. Barriers to successful EBPs include difficulties demonstrating return on investment, limited time of case managers to refer individuals to CBO EBPs, and high costs of staffing and running a program. This resource may support the establishment and sustainability of reimbursable EBP programs as managed by CBOs. The National Council on Aging’s call to action includes, but is not limited to: (1) encouraging broader use of state Medicaid authorities to implement EBPs; (2) developing partnerships and a framework for CBO networks; and (3) identifying value-based payment models for CBOs to participate in.


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