The Opportunity Of “In Lieu Of”

Substituting services is something health plans have long been able to do. Medicaid managed care has especially been able to cover nonclinical services outside their contractual obligations to address prevention, care coordination, and social support needs. Two common ways to cover these nontraditional services are “in-lieu-of” services (ILOS) and “value-added” services. ILOS are services that can be substituted for a similar service covered under the contract—such as home visits instead of clinic appointments for preventive health, or referrals to social services. These services are usually covered when calculating the capitated rate. Value-added services are the . . .