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How Payers Address Deep-Rooted Social Determinants of Health

Targeted wellness outreach and financial investments to community organizations can help healthcare payers manage deep-rooted social determinants of health.

Payers address deep-rooted social determinants of health with historical data and long-term community partnerships.

Source: Thinkstock

By Thomas Beaton

- The social determinants of health (SDOH) have gained traction in payer discussions and are driving payers to take a thoughtful look into factors that create long-lasting effects on healthcare costs and outcomes.

Payers recently have implemented programs to take immediate action towards addressing SDOH. These projects include extensive housing pilots to limit how homelessness exacerbates hospital costs and food security programs to provide a regular supply of nutritional meals to low-income beneficiaries.

Aetna Foundation President Dr. Garth Graham told that immediate action to address SDOH is a positive step forward, but contended that social health determinants are deeply rooted at the community level. He emphasized a need for long-term solutions and partnerships.

“[Programs to address social determinants of health] are not short-term commitments because communities require long term partners,” Graham asserted. “What we at the Aetna Foundation learned is that SDOH require multi-year and multi-stakeholder strategies with a variety of different partners.”

Currently, the Aetna Foundation implemented a “Spotlight Award” program that awards 10 community programs $25,000 to create healthier communities by addressing behavioral and environmental factors of health.

READ MORE: How Payer Philanthropy Can Address Social Determinants of Health

Graham explained that payers must take a thoughtful approach before implementing financial and operational resources to address SDOH.

Garth Graham, MD, President of the Aetna Foundation Source: Xtelligent Media

Payers must be mindful of which social determinants are critical to address based on local factors. Graham learned through his work with the Aetna Foundation that national trends surrounding health equity sometimes don’t factor into a community’s specific healthcare needs.

“For instance, we know that socioeconomic status, education, job opportunities may be important for economic viability in some communities while in others healthcare challenges take root in other types of issues such as the opiate epidemic,” Graham clarified.

Healthcare payers need to effectively leverage geographic and zip code data to identify social determinants as well as the appropriate community partners to effectively address them, Graham stressed.

READ MORE: Bundled Payments Require Clinical Insights, Provider Buy-In

Comprehensive geographic data allows a payer to learn where disparities are in terms of healthcare and wellness access. This data also helps health plans learn about the relevant community stakeholders that have expertise about the community’s characteristics.

“We like to always say your zip code matters more than your genetic code,” Graham said.

“Organizations need to look at and analyze the local data, understand the local dynamics to determine factors with particular importance in a community, and then work with the local organizations to target resources accordingly.”

Ultimately, payers must understand why certain community behaviors contribute to poorer health outcomes. Funding, outreach, data analytics, and other practices to tackle SDOH can improve these outcomes with longer-term approaches.

Graham and his team at the Aetna Foundation found that performing a historical analysis of zip code data is an effective tool to launch multiple campaign aimed at addressing long-term SDOH. The data has allowed the Aetna Foundation to invest thousands in strategic funding and support for local communities and segment SDOH needs at hyper-localized levels.

READ MORE: Member Engagement is Key for High-Deductible Health Plan Success

“We [at the Aetna Foundation] follow the data in terms of the social determinants of health that are particularly important at a local level,” Graham reiterated.

“There might be [community] issues related to food and security that may be unique to a particular community in Florida and requires nutrition-based investments vs. public safety concerns that may be more pertinent to communities around San Diego.”

Academic partnerships are also an effective tool for addressing community SDOH for longer periods of time in the Broward County (Florida) area, Graham observed.

Specifically, the Aetna Foundation forged a partnership with Florida International University (FIU) to help medical students understand deeply-rooted SDOH at the local level. The students go into local communities to learn about the relationships between socioeconomic characteristics and overall health of individuals.  

“[Because FIU] knows that they have a partnership with us that goes beyond a year it allows them to have the medical students and the community groups in longer-term relationships than before,” Graham said. “That is an amazing program I think is definitional for incorporating medical education into the clinical and societal relationships.”

Graham and the Aetna Foundation rely on various methods to identify programs and stakeholders that improve community health, but also utilize significant financial rewards to scale efforts towards addressing long-term SDOH.

He referenced Aetna’s partnership with US News & World that aims to identify and reward over $1.1 million to community programs if they improve population health outcomes. Programs such as food security initiatives and transportation are measured if they provide steady access to nutritional meal options or decrease gaps in healthcare transportation access, respectively.  

Social determinants of health are a major challenge in the nation’s healthcare environment, but payers and non-traditional stakeholders are learning that the skills and tactics to address SDOH can be learned by multiple organizations.

“The lesson we learned is that our tactics are transferable within our industry and that if an organization engages the local community, the local community will respond,” Graham concluded.

“Many times what we offer is support, as well as lessons learned from the experiences of other communities, but in many cases even the most challenged communities do have the resilience and the drive to achieve and move forward.” 


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