Social determinants: The next phase of value-based innovation 1

Social Determinants: The Next Phase of Value-Based InnovationUNDERSTANDING AND INFLUENCING KEY PREDICTORS OF HEALTH OUTCOMES

Presented by RAM Technologies, Inc.

INTRODUCTION At first glance, the social determinants of health (SDOH)

seem beyond the purview of healthcare providers and payers,

but it has become increasingly clear that these factors

are important to health outcomes, and they must be addressed

if stakeholders are to improve the health of vulnerable populations.

Identifying SDOH, integrating data into health records and models,

and using that information to guide interventions are the keys

to improving health and bending the cost curve, but barriers such

as data and stakeholder silos remain. Payers, with repositories

of claims and demographic data as well as advanced analytic

capabilities, are strongly positioned to forge partnerships with

healthcare providers and community groups to surmount these

barriers, address SDOH and unlock value in healthcare.

NATIONAL AND REGIONAL STAKEHOLDERS TARGET THE SDOH 1-4

SDOH are central to the CDC’s Healthy People 2020 initiative –

a list of 1,200 objectives in 42 categories meant to improve public

health nationwide. Meanwhile, coalitions are forming across

the nation to address SDOH. The Camden Coalition of Healthcare

Providers’ citywide care management system, Harlem Children’s

Zone Project, the Colorado Health Foundation’s Healthy Places

initiative and the Healthy Food Financing Initiative are among

the efforts developed to pursue neighborhood-level interventions

by targeting poverty, physical activity, nutrition and more.

Payers are also getting involved. Through the Center for Medicare

and Medicaid Innovation’s State Innovation Models Initiative,

health plans are working with states on population health

improvement models that include a social determinants component.

Other Medicaid payment and delivery reforms also encourage

organizations to consider and address SDOH, and in some cases,

Medicaid reimburses for housing.

3Social determinants: The next phase of value-based innovation

TECHNOLOGY CAN HELP INTEGRATE SDOH INTO CARE 2, 5-11

PATIENT-LEVEL INSIGHTS

SDOH cannot be adequately addressed until they are identified

and quantified. Because SDOH vary between and within patient

populations, interventions must be personalized based on reliable

data capture, sharing and analysis.

The basic electronic health record (EHR) is a foundation,

but to be useful for developing and evaluating targeted

interventions, the EHR must be expanded to include new types

of data. Sources include patient questionnaires, activity trackers

and other medical devices, as well as demographic data. In addition,

data silos must be brought down to allow data to flow freely

to where it can be most effective. For example, payers already

house key demographic information, and when they share it with

providers, clinicians gain a more robust understanding of patients

and may go on to collect additional data.

The result is a more informative EHR that when analyzed yields

insights for addressing SDOH at the patient, community

and population levels. Indeed, HHS “envisions a future where

clinicians in a multi-payer environment obtain actionable,

reliable, and comprehensive feedback data regardless of who

pays for their patients’ care.”

GENERALLY, THE SOCIAL DETERMINANTS OF HEALTH

ARE THE CONDITIONS IN WHICH PEOPLE ARE BORN, GROW, WORK, LIVE AND AGE.

THEY INCLUDE:16

LIFESTYLE FACTORS

• tobacco use

• illicit drug use

• diet

• exercise

• isolation

ENVIRONMENTAL FACTORS

• pollution

• noise

SOCIOECONOMIC FACTORS

• financial stress

• education level

• housing quality

• access to transportation

• access to healthful food

• access to recreation

• neighborhood safety

44 Social determinants: The next phase of value-based innovation

COMMUNITY-LEVEL INSIGHTS

Geographic information systems can be used to identify

communities and neighborhoods with high rates of poverty

and unemployment, low education levels, exposure to pollution,

a lack of transportation, food deserts and other factors that

contribute to poor health. Mapping and analyzing data enables

the development of a community health needs assessment

to guide interventions. The CDC offers resources for completing

such an assessment.

POPULATION-LEVEL INSIGHTS

Payer claims data also holds clues to SDOH. For example,

cardiovascular disease and depression may be linked to stress

caused by insecure housing; environmental factors contribute

to asthma; obesity and diabetes may be tied to poor access

to healthful food; and transportation problems may result

in missed appointments. Claims analyses tease out these and other

associations that might otherwise be missed. Payers that share this

and other data with clinicians and other partners arm them with

the insights needed to truly make a difference.

STANDARDIZATION IS KEY

Clinical SDOH assessment tools have come to the market,

but the field lacks standards, guidance and best practices for multi-

sector data sharing and systematically capturing, documenting

and prioritizing SDOH. Various efforts are underway to fill the gaps,

and some stakeholders have introduced tools for measuring SDOH.

In addition, the National Association of Community Health Centers,

Association of Asian Pacific Community Health Organizations,

Oregon Primary Care Association and the Institute for Alternative

Futures have joined forces to implement, test and promote

a standardized risk assessment protocol to assess and address

patients’ social determinants of health.

5Social determinants: The next phase of value-based innovation

HOW PAYERS ARE LEADING THE WAY 1,4,5,12-15

In addition to data sharing and analytics, payers are strongly

positioned to take SDOH to the next level in other ways —

indirectly through provider and patient incentives and directly

through philanthropy.

Value-based insurance design is one framework for encouraging

providers to collect and use SDOH data, and many payers have

already launched pilot programs in this area. Identifying SDOH

allows health plans to not only waive cost-sharing for key services

but also to cover food as medicine and provide housing

and transportation assistance, for example.

Major health plans also continue to leverage partnerships

with community organizations to identify and address SDOH.

These payers are investing directly or through community groups

in interventions that improve housing, transportation, employment,

nutrition, education and health behaviors in the patient populations

they serve, and in at least one case, adopting a “whole patient”

perspective for high-cost, high-need patients that accounts

for social determinants. In addition, Association for Community

Affiliated Plans members are testing myriad programs and initiatives

to improve housing, economic stability, education and food security

in the patient populations they serve.

Payers are strongly positioned to take SDOH to the next level — indirectly through provider and patient incentives and directly through philanthropy.

LOOKING TO THE FUTURE 2,4,16

The transition to value-based care is well underway, but continued

progress is needed to optimize healthcare and outcomes

if stakeholders are to build a more sustainable system.

Research has shown that SDOH are at least as important to patient

outcomes as medical care itself, and for Medicare, Medicaid

and dual-eligible populations, SDOH are particularly important.

As value-based care places new emphasis on prevention

and outcomes, stakeholders have realized they must find a way

to account for SDOH, and many have pursued efforts to influence

social determinants as a result. This is the next phase

of value-based care.

To effectively identify and influence SDOH, data silos must

be eliminated, partnerships formed and tools for integrating

SDOH interventions into clinical care must be developed.

These efforts will require stakeholder support, investment,

incentives and new ways of thinking about healthcare. Payers

have the perspective, resources and tools to ensure SDOH are fully

recognized and addressed as an integral component of healthcare.

These efforts will require stakeholder support, investment, incentives and new ways of thinking about healthcare.

7

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