The understanding that social determinants of health (SDOH) play a pivotal role in health outcomes has been a game changer in the way healthcare organizations across the country approach member engagement and supplemental benefit programs.
Eliminating health disparities has been a focus for many organizations and the COVID-19 pandemic has accelerated the importance of initiatives aimed at addressing the clinical and non-clinical needs of minorities and low-income individuals and families, as we’ve seen those populations more adversely affected than others by the pandemic. From education and health literacy levels to employment status and food security to social connections and support, SDOH have a significant impact on health outcomes. Addressing SDOH will reduce health disparities rooted in underlying social, economic and environmental disadvantages while improving the overall health of these populations.
Health payers are continually seeking to drive greater clinical and quality outcomes for their members while being mindful of their economic performance. With only 10% of overall health attributed to clinical care and 40% attributed to social and economic factors, it is clear that effectively addressing SDOH can significantly contribute to the improvement of health outcomes, thus reducing healthcare utilization in the long term. Health payers share a core mission and social responsibility to support the members and communities they serve, and value-based arrangements acknowledge the quality of healthcare delivered and improved health outcomes. Whether you are considering the issue of SDOH from a quality, social or economic perspective, reducing health disparities and improving health outcomes by addressing SDOH are key strategies for change.
Figure 1: What Contributes to Overall Health
Source: Susan Denzer, Forging a National Agenda to Advance Health Care Without Walls, AHIP’s National Health Policy Conference, March 13, 2019
The role that SDOH health play in overall health outcomes is currently being studied and addressed across many sectors of the healthcare industry. The use of SDOH to make meaningful changes in an organization is not without challenges. Access to member data on SDOH has been identified as the biggest hurdle to addressing social risk factors that contribute to poor health outcomes. How do you collect reliable, quality data on SDOH? Sources of SDOH data include U.S. census data, geographic data and documentation of ICD-10 Z-codes. (Note: A previous blog post provided additional detail on leveraging ICD-10 Z-codes to improve care. The use of these codes is growing as the industry becomes more consumer-centric, focusing on holistic care.
The Gravity Project is a national collaborative initiative to expand available SDOH data for interoperability and expedite the exchange of SDOH data. Facilitating the integration of SDOH data into patient care will empower payers, providers and health systems to address social risk factors, improve health outcomes and reduce health disparities.
Last year, CMS announced that beginning with the 2019 plan year, Medicare Advantage plans can provide supplemental benefits that address SDOH for identified members. Nationwide, health plans are expanding programs to incorporate SDOH-related benefits such as: telehealth, expanded transportation options, meal delivery, fitness programs, adult day care and home safety improvements. To maximize impact, a collaboration with payers, providers and members is essential in addressing social risk factors to improve health outcomes and member satisfaction while controlling costs.
Member engagement has been a challenge for payers and providers, from effectively targeting and reaching member needs to engaging members to be proactive in their healthcare. With the added complexity of designing, implementing, marketing and delivering new benefit programs that address SDOH, a multi-prong approach and implementation plan is key to enhance member participation, retention and satisfaction. Successful strategies target and engage the right member through the right channel with the right message at the right time. Through a targeted and personalized multi-channel outreach strategy that involves coordination between payers, providers and community-based organizations and resources, the clinical and non-clinical needs of members can be addressed and gaps in care closed to improve the overall health of members.
This multi-faceted approach involves deep analytic insights, flexibility and choice, incentives, and targeted communications to drive member engagement:
Integrated, data-driven technology platforms empower payers and providers to meaningfully impact the health of their members and patients by facilitating the clinical and SDOH data collection and analysis, identifying members to target, and highlighting member and provider engagement and point-of-care solutions. With the right tools, collaboration among healthcare stakeholders, and consistent use of ICD-10 Z-codes to capture SDOH data, we can improve the overall health and quality of life of members while reducing health disparities and unnecessary costs.