Last month, I attended the AHIP Institute & Expo 2019, where Geneia was a sponsor, and delivered a presentation titled Improving Care Management with Predictive Analytics, Social Determinant Data and CRM, where I discussed the need for a holistic solution to population health management that incorporates complete and shared member data, analytics and insights to help care managers identify and prioritize members by risk, and customer relationship management technology allowing for personalized outreach and engagement.
In fact, social determinants of health (SDoH) dominated the conference, with multiple presentations and general sessions devoted to various aspects of SDoH issues from speakers including:
Sam Kass, former senior White House policy advisor for nutrition and executive director, Let’s Move!; founder, Trove; partner, Acre Venture Partners; author, "Eat a Little Better: Great Flavor, Good Health, Better World"
Vivek Murthy, MD, 19th Surgeon General of the United States
Elena Rios, MD, MSPH, FACP, president and CEO, National Hispanic Medical Association; president, National Hispanic Health Foundation
AHIP unveiled an initiative called Project Link, a learning collaborative that will convene payers and stimulate conversation and solutions around social needs. And Cigna Chief Executive David Cordani in his keynote spoke about consumers’ desire for health insurers to “know me, help me and make it easy,” alluding to the need for personalized attention; solutions that address the total person including SDoH, behavioral health and dental; and tools and outreach that makes it easy for consumers to engage in their health and be successful over the long-term.
Why the buzz
Undoubtedly, SDoH is an incredibly pervasive and relevant topic right now and for good reason. Social determinant data is driving more care decisions and is critical to understanding health risk, engagement and predicted outcomes.
Four statistics help to explain this:
- Health costs continue to rise: in 2017, health costs were $3.5 trillion and, by 2026, are expected to rise to $5.7 trillion
- Medical care accounts for only 10-20 percent of health outcomes, while 80-90 percent are attributed to demographic, environmental or socioeconomic factors (SDoH)
- Social needs are prevalent: 68 percent of patients have at least one SDoH challenge; 57 percent have a moderate to high risk of financial insecurity, isolation, housing insecurity, and/or health literacy
- Value-based care continues to grow: 59 percent of healthcare payments are tied to value-based payment models, which means healthcare providers who are paid for quality and outcomes need to examine areas outside the clinical settings to impact change
Addressing SDoH matters to your members
Aside from the importance of SDoH factors to overall health outcomes, health plans and physicians should also consider the implications for engagement and member satisfaction.
We know that high engagement and coordinated care are essential for improved outcomes, but that only about 25 percent of members feel they receive coordinated care from their health plan. There are also implications here for coordination around addressing social determinant needs. Consider the following from a recent Kaiser Permanente survey: Patients who need social supports are primarily turning to the internet and their family and friends for information, although most agree doctors and health insurance plans should be leading the charge in this arena.
- 42 percent of patients ask their doctors about social services available to them; however, nearly all agreed their doctors should ask about SDoH
- 93 percent want their doctors to ask about access to healthy food
- 83 percent want providers to ask about access to stable housing
- 78 percent agreed providers should ask about loneliness or social isolation
- 77 percent said doctors should check on patient transportation to work, school and other social activities
- 50 percent patients said they would feel more supported by their providers if they asked about SDOH
Members are more aware of the role social factors play in their own health and they’re looking for help from the healthcare system to address them. This is a critical need and presents a key opportunity for health plans and providers to work together on these issues – to integrate SDoH data into population health management platforms, patient intake surveys and the EHR – to better identify members with social health needs and refer them to community-based programs where appropriate.
To learn more about how health plans and providers are using social determinant data to identify and prioritize rising-risk and chronically ill members, download our white paper.