Employing Social Workers to Address Social Determinants of Health

October 03, 2019 - Payers are trying to understand their role in addressing the social determinants of health. These non-clinical factors that impact an individual’s health include environment, housing, food insecurity, and transportation. Some payers are expanding benefits to cover these much-needed services for their members while others are investing in community-based programs that work to improve the health of communities.

Florida Blue hired social workers to help community members in their retail centers navigate benefits and connect them with social services.

“We see these social workers, or as we refer to them as community specialists, as really being a critical part of realizing our mission and the next step in our efforts to achieve our mission,” Sarah Iselin, MS, executive vice president of government programs and diversified business told HealthPayerIntelligence.com. “We take a holistic approach to helping people and communities achieve better health.”

Community specialists are the newest addition to the services Florida Blue provides members and non-members at their 26 retail centers throughout the state. Other services include nutrition advice, wellness programs, health education, care consulting, benefits navigation, health tech demonstrations, and fitness classes.

While some services are limited to Florida Blue members, community specialists can help anyone who walks in a center’s door.

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“People could always come into our retail centers to ask a question about health insurance benefits, sign up for a policy, or chat with the nurse and get their blood pressure checked,” Iselin explained. “Anyone can walk into one of these retail centers, whether they’re a Florida Blue member or not.”

Florida Blue, Iselin said, understands that addressing the social needs of the community is a natural extension of their mission.

"We recognize at Florida Blue that health goes beyond traditional boundaries of healthcare. One of the things that makes us unique as a health plan is that we are focused locally," she noted. "We take a holistic approach to helping people and communities achieve better health. That’s our mission.”

Many health plans previously saw addressing social determinants of health as something outside of their wheelhouse. More recently, payers are recognizing the importance of addressing these factors to better the health of their members. Because the industry shifted its thinking, there was little resistance from Florida Blue stakeholders to change, Iselin said.

“There is a much broader recognition than there ever has been before about how many other factors in people’s lives impact their physical health,” she noted. “More folks have a deep appreciation for the fact that having a safe place to live, affordable housing, access to healthy food, and access to good childcare have an impact on your physical health and your mental health.”

READ MORE: Better State Policy Needed to Address Social Determinants of Health

“It’s reflective of a much deeper understanding in the healthcare community about more than their use of the healthcare delivery system,” Iselin furthered.

This shift in focus to the whole person instead of individual care delivery is not just leading to better patient care, but it is improving business strategies. 

“We need to consider all aspects of members’ lives that can have an impact on their ability to successfully manage a disease, stay out of the hospital, and live the life that they want to be living,” Iselin explained. “It’s good business. Health plans that embrace and absorb these lessons are going to be the ones that people pick to be their health plan because they have their back.”

While Iselin noted it is difficult to quantify the efforts they are making and their cost savings, their organization is tracking customer-satisfaction metrics and the amount of assistance provided throughout the year to further emphasize the impact they are having.

"We measure satisfaction through net promoter score of everyone who comes int our retail centers, including folks who interact with the community specialists," Iselin emphasized. "We ask these questions so we can learn, improve, and continue to refine how we are supporting our local communities in achieving better health in the most meaningful and impactful ways.”

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Tracking interactions helps Florida Blue quantify the value of the services they are providing more directly, gives them a sense of how many individuals they are impacting, and outlines common problems community specialists are helping members and non-members navigate. Ultimately, though, these measures cannot fully capture the impact Florida Blue is having on these social determinants of health in their communities.

“When you’re doing things like helping someone get clothing for a job interview and refer them to a local employment agency, it’s tricky to measure the impact on someone’s life,” Iselin said. “Frankly, it’s not the reason we do it. We do it because it’s the right thing to do. We do it because it’s an extension of our mission.”

Iselin outlined examples of how community specialists are helping members and non-members in this way.

“We had a grieving mom who had recently lost her child and was really in need of support. She was able to walk into our retail center. She didn’t have reliable transportation or access to a computer,” Iselin explained.

A community specialist helped this member find resources and scheduled her an appointment for a counselor.  

In another example, a non-member walked into a retail center and a community specialist learned that this individual was likely eligible for Medicaid but did not know how to enroll.

“Not only did the social worker help this individual apply for Medicaid, but while the social worker was doing that, she determined that the individual was also eligible for assistance with food. The social worker got the person connected to an immediate free clinic where they could get food while waiting for approval of the Medicaid eligibility,” Iselin said.

These steps, while hard to quantify for their return on investment, can exponentially impact an individuals’ life for the better, a key component of Florida Blue’s mission.

“We’re trying to support and help navigate life,” Iselin concluded.