Health plans are on a constant quest to learn what they can do to help their member populations. Unfortunately, there is a scarcity of practical information for health plans to act upon when scanning media coverage and internet sites that purport to provide helpful guidance.
For example, the World Health Organization actually describes social determinants of health, or SDoH, as “non-medical factors that influence health outcomes.” This simple designation complicates matters, as non-medical factors make the issue seem more daunting to health plans. The health plans do not have any control over these factors, and they are trying to connect with members. The SDoH only serves to impede the health plan’s goal of connecting with its members.
The problem with SDoH for health plans, ultimately, is that they fall outside the normal flow of data and process. Unlike claims and clinical data, there is no standardized data classification system. In addition, capturing this data on an individual basis is challenging.
Oftentimes, community-based organizations (CBOs) have some information and even provide services, but they don’t have sophisticated data collection systems in place. This is made even more difficult as the proper way to address SDoH factors is often ill-defined, if defined at all. The new generation of practitioners is trained to ask and observe more socioeconomic factors, but how do they address them? How does a physician or nurse help alleviate housing or food insecurity or inadequate access to affordable healthcare?
The health plan knows this is a substantial factor, but how to systematically address this to improve outcomes and lower costs is a pressing concern with no clear answers.
Meeting Contemporary Demands
If you do not have the data, how can you even begin to effectively impact the problem? The issue is not only the lack of information but also the fact that the information that is there can be ill-suited for systematic analysis. Even when data becomes available, the intervention engine (and the funding required to rectify that issue) is not readily available for plans or providers.
But it’s not all doom and gloom. The industry understands that it must focus on SDoH and accept that this is a crucial societal dilemma that needs an all-hands-on-deck solution. Millennials are a perfect example, as they are quickly becoming the core part of health plans. They want to buy from and/or work for companies that are impacting the world in a positive way. The health plans offered are extensions of that vision, so providers must endeavor to create a plan so they can maintain membership.
The dramatic circumstances of the past couple of years have put a spotlight on social equity and disparity. SDoH factors can be measured to some extent, which means social disparity can be as well. Social equity is much harder to measure, but we know that safe and affordable housing, access to education, toxin-free environments, and crime-free neighborhoods are harbingers of better overall health. The differences are alarming when compared to communities with poor SDoH.
Uncovering Realistic Answers
In short, health plans absolutely need to have clear strategies for confronting SDoH. We should want to solve the problem and help those who need assistance. It’s a higher calling. And remember: Society keeps receipts. The news media might miss it, but Twitter and other social media platforms will rise up and call out health plans if they do not have a strategy on SDoH. In today’s hyperconnected world where everyone with a smartphone is an intrepid reporter, few injustices go unnoticed.
Here are some tactics that health plans can implement as they search for answers in helping their member populations with regard to SDoH:
1. Support data classification efforts. Health plans should invest heavily in robust, agile data classification frameworks within claims and clinical systems. Once a proper system is in place, it will be significantly easier to compile and organize SDoH factors into an algorithm that favors action over apathy.
2. Look for ways to align with CBO providers. When you seek to understand the realities of a certain community, link up with its leaders who have boots on the ground and active, useful knowledge of that community. Unite Us is one organization that comes to mind, which works to establish closed referral networks that give providers a way to direct proper care to those with socioeconomic needs.
3. Make this a companywide priority. Your IT and analytics folks will spearhead these efforts, but it’s important to have buy-in from the C-suite all the way down to the call center floor. And don’t skimp on creating a road map to success. Craft a long-term strategy for addressing this, but build some flexibility into it. Learn from failures, and keep pushing forward — no matter what.
Social determinants are known factors impacting member health, and ignoring the problem will not make it go away. However, you can take a multiyear approach to this issue and make some headway. Member health, patient outcomes, and cost all hang in the balance, and time is of the essence.
About Jeff Maxwell
Jeff Maxwell is the executive vice president of healthcare solutions at NextHealth Technologies. He has more than a decade of experience working with healthcare organizations, health systems, and health plans.
