How can health plans address social determinants and improve member health outcomes?

Social determinants of health (SDoH) have a major impact on individual and population outcomes. Health plans are constantly striving to improve these outcomes and member experiences. By assessing social factors and addressing the challenges pertinent to those factors, payers can positively impact member-population health. A deeper understanding of factors that affect members' health can significantly reduce utilization and costs, thereby improving the overall plan performance.

Prevention is better than cure. Early identification and treatment of disease is more productive and less costly than emergency episodes of disease. However, the healthcare system is still not quite there yet; the processes still aren't efficient enough to encourage early intervention. But there is scope for reducing emergency episodes. To achieve this, it is important to focus on each member's health history individually and learn about their environment.

Factors that are generally included as SDoH — housing, transportation, lifestyle, community, locality and education — have major roles in determining a person's health status. Incorporating pertinent data about these factors into patient management considerations is bound to improve the accuracy and speed of diagnosis, treatment plans, medication adherence, and health outcomes. However, accumulating the data and channeling it to the point of care is a challenge. Accessing and leveraging SDOH data in the care journey is the next milestone of healthcare.

Identifying and analyzing social determinants of health

Data from SDOH can be utilized by payers for health risk assessment, patterns of resource utilization, and other purposes. One of the key processes for improving member population health is identifying and stratifying high-risk members and then enabling the provider and care network to address them. Analyzing and developing a deep understanding of social factors can help health plans create more customized care plans, thereby reducing hospitalizations and emergency visits.

Socially and economically disenfranchised members will need to leverage community resources to stay healthy, and those resources need to be available to them.

Take, for instance, an elderly man who was sent back to his home after major surgery. He, however, did not have anybody to help him with cooking, cleaning and basic chores, and was thus unable to recuperate at home. If he had access to community resources, such as home care services or meal delivery programs, he would have had less struggle with his daily needs and his recovery rate would likely have been much faster. He also would have been less susceptible to hospitalization due to lack of at-home care.

It is important that payers ensure they are connected to their members, and that their members are connected to providers, caregivers, and community resources so that they stay healthy, satisfied and engaged.

Enabling providers and caregivers with actionable SDoH insights

Accessing SDoH data alone is not enough to put that data to use. Predictive analytics must be applied to the data to assess the at-risk population, derive insights from it, and devise strategies to use the information to mitigate emergency visits for each member.

To drive improved health outcomes for a health plan, it is critical to identify members' health status and patterns in their medical health history. Leveraging members; utilization trends and clubbing them together with their social determinants can help providers and caregivers gauge the true picture of a member's health status. Diving deeper to identify ZIP code levels and census data can help identify members’ surrounding environmental conditions, contributing valuable information for devising care plans for them.

How to leverage SDoH

Pairing the data together == the clinical data and social factors — can be challenging, as they come from different data sources and are not aligned in terms of standard, formats, and more. Innovaccer's Healthcare Data Platform for Payers can seamlessly integrate healthcare data from traditional sources with SDoH. Additionally, it also analyzes which social determinant of health most directly impacts patients, and drills down to every measure at national, state, and county level and strives to paint a clearer picture for care teams. It compiles county-level data for every social determinant of health and analyzes it to help providers understand the impact of various SDoH and track the performance of each county against national and state averages.

The road ahead

It is a universally acknowledged fact that health outcomes are 80 percent dependent on SDoH. Even the best clinical care can fail if social factors are ignored. Healthcare costs are still skyrocketing, but the outcomes are below satisfactory levels. Much of this divergence stems from the overuse of emergency visits and hospitalizations that could have been prevented had SDoH been accounted for. The identification, analysis and leveraging of SDoH data represent an opportunity to bridge the cost-quality gap and boost health outcomes.

For most diseases, cures are available. But curing diseases is not the only function of the healthcare industry. Preventing and predicting diseases is as important as treating patients, if not more. It is important to stay ahead of illness through leveraging technology, addressing concerns at the right place and time.

To learn how you can leverage SDoH data to advance the goal of member-population health, get a demo.