There’s a growing body of research that affirms what I and most of my nursing colleagues have long known. What happens outside of a patient’s clinical care – where a patient lives, what they eat and whether they have a support system – all have a tremendous impact on patient health. In fact, research suggests medical care accounts for only 10 – 20 percent of health outcomes while the other 80 – 90 percent are attributed to environmental and socioeconomic factors and individual behavior, collectively known as social determinants of health (SDoH).
Social Determinants of Health Research
Physicians too know the importance of social determinants. A recent Leavitt Partners study of physician attitudes about SDoH found:
- Transportation: 66 percent of physicians believe assistance arranging healthcare transportation helps patients
- Housing: 45 percent say affordable housing aids patients
- Food: 48 percent believe getting sufficient food benefits patients
- Income: 54 percent consider income assistance a help to patients
- Healthcare pricing: 75 percent say patients benefit from information about the price of healthcare and health insurance
Given the profound impact social determinants have on patient health outcomes, it makes perfect sense that addressing a patient’s housing, transportation and food needs reduces health spending. Research has shown this to be true:
- A 2016 study by the Robert Wood Johnson Foundation reported a 17 percent decrease in emergency department use, a 26 percent reduction in emergency spending, a 53 percent decrease in inpatient spending and a 23 percent decrease in outpatient spending.
- Research conducted by WellCare Health Plans and the University of South Florida College of Public Health found connecting patients with social services to address SDoH generated a double-digit healthcare spending reduction. The study reported an additional 10 percent decrease in healthcare costs – equating to more than $2,400 per person per year savings – for Medicare and Medicaid members who were successfully connected to social services compared to a control group of members who were not.
- For some common chronic conditions such as diabetes, hypertension, diabetes and coronary artery disease, a Moody’s Analytics study for the Blue Cross Blue Shield Association showed social determinants drive larger differences in the health impacts.
- Geisinger Health System’s Fresh Food Farmacy program provides 15 hours of education about diabetes and healthier living, followed by 10 free nutritious meals a week for diabetics and their families. It costs $2,400 per patient per year to operate the program, and early research shows an 80 percent reduction in the overall health costs: from an average of $240,000 per diabetic member per year to $48,000.
Physicians: ‘Surely, someone else is better positioned to address SDoH’
The Leavitt Partners study also demonstrated physicians do not believe it is their responsibility to address social determinants. By and large, the physicians surveyed felt someone outside the office or practice is best-positioned to help patients. For example, nearly half of physicians believe housing assistance would help their patients, and at the same time, 91 percent do not see themselves or health plans as responsible for helping.
Survey results showing who physicians believe is best-positioned to help patients with SDoH needs
Geneia’s population health engagement specialists work one-on-one with health plan members to address SDoH
To address these ever growing needs impacting health outcomes outside of clinical care, Geneia uses population health engagement specialists to outreach, engage and educate health plan members. They bring experience working in clinics, hospitals and other healthcare settings, and can also have training as certified medical assistants, to work one-on-one with members. Under the guidance of our clinical team, our engagement specialists help members who have been identified through clinical algorithms and protocols as needing additional support. The type of work they do ranges from calling members who have HEDIS® preventive care gaps, helping them schedule appointments, and in many cases, arranging for transportation to coordinating care and identifying other programs and resources for patients with complex or ongoing needs.
As value-based care arrangements proliferate, roles like this will continue to be critically important to quality outcomes and a key addition to the care team. They offer the real possibility of bettering patient lives by connecting with them one-on-one while reducing costs and improving health outcomes, all the while assisting physicians by helping to address the additional needs of the patient/member. In other words, they have a direct and meaningful role in helping healthcare organizations achieve the Quadruple Aim.