The healthcare industry has made strides to free itself of paper-based processes and disjointed incentives for stakeholders. There is significant opportunity to continue to improve how care is delivered with a new and healthier attitude toward the use of technology.
This healthier attitude comes from a new generation of healthcare stakeholders who are more apt to use technology in their personal and professional lives and more experienced healthcare leaders who have integrated technology successfully in several places.
Value-Based Reimbursement (VBR) models, along with these advances in healthcare technology and a growing demand for analytics, have kicked off a new era of transformation. The new era will focus on developing a deeper understanding of the populations served by healthcare organizations and how social determinants of health (SDOH) influence treatment outcomes. SDOH are social, economic and environmental conditions in which people are born, grow, live, work and age that impact their health.
The article will highlight how different healthcare organizations are approaching SDOH and how they can use socioeconomic data to jumpstart these efforts. In addition, the article will demonstrate how SDOH can play a key role in increased financial returns possible under the VBR models, such as the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) and other payer-driven performance bonus programs.
How are payers addressing SDOH?
America’s Health Insurance Plans (AHIP) recently issued a brief, “Beyond the Boundaries of Health Care: Addressing Social Issues,” regarding how health plans are addressing social issues to impact a person’s overall health. According to the brief, overall health is determined by individual behavior (40 percent), genetics (30 percent), social circumstances (15 percent), environmental factors (5 percent) and healthcare (10 percent).
Considering the future of VBR, the most striking implication of these estimates is that medical care alone has a very limited effect on overall population health. The case studies highlight the multifaceted, multi-stakeholder approaches needed to coordinate healthcare and social services.
Let’s take a look at one of those programs. One nonprofit managed care plan working across multiple states and insurance products launched a program in several states to address financial determinants of health. It supports members by helping them get and keep jobs. The program identifies and closes gaps in educational needs and job skills then links members with employer partners. The program also provides life coaches or assistants, a growing trend among plans to help members utilize multiple resources to support unmet social needs. The work started by the plan to resolve unmet social needs will support members on their path out of poverty and on to success in their jobs and in their health.
In another example, University of Pittsburgh Medical Center (UPMC) has started an innovative program to address housing needs where participants gained an annual health savings of $6,384. Many other payers are launching SDOH-based programs. They focus on increasing health screenings for complex conditions to identify high-risk patients or to promote wellness programs.
Providers increasing interest in SDOH
Deloitte recently conducted a national online survey of hospitals and health systems, Addressing social determinants of health in hospitals, to establish baseline metrics against which healthcare organizations can measure their efforts toward addressing SDOH. According to the analysis, 80 percent of hospital respondents reported that leadership is committed to establishing and developing processes to systematically address social needs as part of clinical care. The report noted that interest is high, but activity is currently fragmented and ad hoc. While hospital investments vary, the shift of healthcare systems toward value-based care may spur more investment and activity around addressing social needs.
Most hospitals stated that improving health outcomes (70 percent) and improving the patient experience (57 percent) are the most important goals underlying their strategy on health-related social needs. However, the majority of hospitals are not tracking health outcomes as part of their metrics. This is a key area of opportunity for providers to gain greater insights into the populations they serve.
Socioeconomic data could support evaluations of populations to better understand depression rates correlated to SDOH like financial stability or community context. Social determinants can also be correlated to events such as frequent ER use or no-show rates. With this knowledge, addressing SDOH that drive these events could help providers design strategies to reduce no-show rates and unnecessary ER use.
Technology vendors integrating SDOH
The Office of the National Coordinator for Health Information Technology, Office of Standards and Technology, recently held the Interoperability in Action Webinar Series #2, “Advancing Interoperable Social Determinants of Health.” The webinar focused on the current state of interoperability of SDOH screening and assessment tools in care delivery, and described their role in newer care and payment models. Many presenters discussed the use of a variety of screening tools within and outside of electronic health record (EHR) systems.
The numerous examples demonstrated the overwhelming interest across the healthcare community to capture a more holistic view of an individual and the factors that influence their health. Cerner most recently announced plans to offer social assessment forms in its inpatient EHR product. The tool is meant to help Cerner’s clients better screen for SDOH.
Enhance outreach and care coordination while increasing financial returns
The underpinning of the VBR care model is the recognition that many health conditions or procedures can be avoided with proper care and interventions. One study demonstrated that treating diseases or disabilities resulting from potentially changeable behaviors costs at least 25 cents of every healthcare dollar. Additionally, findings show that patients who are not active in their own care incur 8 percent to 21 percent higher costs than actively involved patients, and they are nearly twice as likely to be readmitted within 30 days.
It follows that proactive outreach to high-risk individuals is vital for success of a risk-based business model tied to health outcomes. This approach requires a much deeper understanding of the populations than medical data alone can provide. This is where socioeconomic data is invaluable as it can help healthcare organizations accomplish two major goals:
- Find high-risk patients that will benefit from immediate intervention;
- Focus on prevention
For payers, these actions can include offering members with chronic diseases resources to manage their conditions and reduce severity as well as promoting healthy lifestyle with cash bonuses. Importantly, providers can factor in SDOH in their discharge planning to prevent complications and readmissions.
Opportunities for implementation
When augmenting their risk and care management programs with socioeconomic data, organizations have to ensure that SDOH have been clinically validated against actual healthcare outcomes. This is vital for the success of predictive analytics because not all determinants correlate strongly to health outcomes. Organizations should use the most up-to-date, complete and longitudinal data that has been proven to be consistently linked to specific patient populations. For example, LexisNexis Health Care derives attributes from public records data such as education, income, proximity to relatives, bankruptcy, addresses and criminal convictions.
Organizations can jumpstart their efforts with two main ways of implementing SDOH: as attributes and as scores.
They can incorporate SDOH attributes, such as education or income, into existing predictive models and care management based on medical data to better assess and predict risk for individuals. Moreover, SDOH provide critical insights in the absence of medical data. Remember, studies have shown that up to 50 percent of an individual’s health risk can be attributed to social determinants of health.
Another way of utilizing SDOH is through predictive health scores that score a patient’s health risk. Scores are based on hundreds of relevant socioeconomic attributes to paint a full picture of the individual’s future risk.
It should be clear that VBR and SDOH have become key parts of the new normal in today’s healthcare environment. Socioeconomic data provides a more holistic view of individuals, helping organizations direct often limited resources where they are needed most while getting a more accurate picture of future risks than is possible with only medical data.
Proactive interventions enabled by SDOH can lead to reduced financial risks, improved performance and cost of care avoided, positioning both payers and providers for improved financial performance in the VBR care delivery and payment model. Notably, all these actions will help engage and keep individuals as healthy as possible.