Challenges of Investing in Social Determinants of Health

August 06, 2019 - Despite widespread industry calls to prioritize community health benefits, investing in social determinants of health can be risky for health payers. Between questionable return on investment and difficulty forging relationships with community partners, designing these benefits can be a tall order.

Nonetheless, payers are stepping up to the plate, offering grant funding to social services groups and developing their own community health benefits as a part of their various health plans. Most recently at UnitedHealthcare, the payer has dedicated $400 million to address housing, a key social determinant of health, and is now investing another $1.1 million to non-profits in Ohio.

And the decision to do so was easy, despite what can often seem like insurmountable challenges, according to Nicole Cooper, MD, the payer’s vice president of Social Responsibility.

The moral reasons regarding why payers should make investments are clear to most, Cooper noted.

“We know that our investments will have long-lasting impact, not only for UnitedHealthcare members but for the vast majority of people who may indeed not be UnitedHealthcare members,” Cooper told HealthPayerIntelligence.com.

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However, deciding if and how to invest in these solutions can be challenging for a number of reasons.

Most organizations have a hard time seeing any major return on investment for these interventions, keeping some payers from creating community health benefits, according to a 2018 Health Affairs study.

Cost-benefit analyses can also be difficult to define. And since the work on the ground is often executed with a third-party such as a local non-profit, a crucial element lies outside of the company’s influence, leading, unfortunately, to potential distrust between payer and social services.

Payers may also be concerned that members of the communities they invest in will ultimately switch to another plan before the investment takes effect, particularly in Medicaid.

In their northeast Ohio market, UHC leaders saw a fragmented coordination between these different social services, leading to disconnected benefits.

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Despite these challenges, Cooper found hope in the results she saw from previous UHC interventions outside of Ohio. Community health benefits can cut costs for the health payer in addition to fulfilling what it sees as a philanthropic obligation.

UHC’s housing accessibility interventions for homeless persons in Arizona, for example, cut the individuals’ average healthcare costs by 50 percent while emergency department visits dropped by 60 percent. UHC’s food programs have also seen success in lowering readmission rates.

These were clear returns on investments that saved members, providers, and UHC money as a result of their investment in ensuring the communities’ basic needs were met, Cooper explained.

In order for interventions to be successful, Cooper emphasized the need to work together with local social services providers who have long been entrenched in the area.

In Ohio, UHC is partnering with Ohio Association of Foodbanks, East End Neighborhood House, Helen Keller International, and Senior Citizen Resources to address transportation, food security, and vision care.

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Payers have a responsibility, she said, to collaborate on the local level to establish supportive public-private partnerships that will result in new solutions.

“UnitedHealthcare sees itself as one of many critical partners,” Cooper added. ”We're a willing partner, and we want to work alongside many other actors in and outside of the healthcare field to really get this right,” Cooper added.

To Cooper, the challenge of having such a diverse and high quantity of health system partners also presents an opportunity.

“We have an opportunity to further integrate those systems much more meaningfully for the people that we cover and for the communities that we're responsible for improving the health of,” she said.

“We take that charge very seriously and are thinking much more innovatively around bringing services together in a coordinated fashion to really begin serving the whole person, which is not easy, again, because of the lack of integration that exists across our healthcare system.”

UHC will be integrating the four non-profits in Ohio so that they can pool their resources and build a strong clinical and social services system for their communities.

UHC’s goal is to see the local non-profits strengthened in order to better serve their communities.

“We're hoping that the $1.1 million investment that we've made in this particular market really does help with the capacity of much needed and longstanding community-based organizations that have served as anchor institutions within their communities for quite some time,” Cooper said. “You will see much more from us as we continue to scale these programs because what we've seen so far shows us that they have nothing but positive returns for our members.”

This grant is part of UHC’s Empowering Health initiative, the company’s campaign targeting social determinants of health.

Clarification 8/6/19: UHC clarified that its $400 million investment will particularly benefit housing projects, not social determinants of health programming as a whole.