Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Claims Management News

Payer Collaboration Can Address Social Determinants of Health

By collaborating with community organizations and local stakeholders, payers can help to address the impact of social determinants of health.

Payers collaborate to address social determinants of health

Source: Thinkstock

By Thomas Beaton

- Billions in overspending on medical costs are attributed to social determinants of health (SDOH), and SDOH can identify if beneficiaries covered by insurance plans are at risk for adverse health conditions outside their coverage.

SDOH include all of the factors that impact an individual’s health outside of their traditional contact with the healthcare system.  These include societal and environmental conditions like socioeconomic status, education level, language fluency, cultural differences, employment status, and level of access to healthcare.

According to a new report from AHIP, these determinants have an extremely potent effect on an individual’s overall health.

“Some researchers have estimated that overall health (and risk of premature death) is determined by individual behavior (40 percent), genetics (30 percent), social circumstance (15 percent), environmental factors (5 percent), and health care (10 percent),” the report reads.

In order to help healthcare providers, public health officials, and community organizations need to address socioeconomic issues that may negatively impact outcomes, payers must develop a clear understanding of the challenges faced by patients in their daily lives.  

To combat the negative health outcomes produced by care disparities and socioeconomic issues, many payers have engaged in partnerships and collaborative projects that leverage existing resources in the community. 

The AHIP report highlights several successful initiatives from across the country that are helping to improve access, reduce care disparities, and supplement population health management efforts from both payers and providers.

“Designing a program to work on multiple levels with multiple populations concurrently, using evidence-based practices from a comparable sample, has proven very challenging.” the report says.

“To achieve community-wide improvements, stakeholders implementing such changes must understand the population being addressed to ensure that the right programs are targeted to the right people in the right way. Those designing and implementing programs also need to gain community buy-in to achieve the best results.”  

Anthem, for example, has taken on these challenges by launching a partnership with the National Urban League, City of Hope, and Pfizer to improve breast cancer and heart disease care in African American communities nationwide via survey and online modules.

The program, Take Action for Health, also promoted emotional wellness through interactive web tools and surveys in these communities as well.

The pilot program increased participation in screenings for blood pressure, breast cancer, depression, and anxiety in Indianapolis, Kansas City, and Houston.

Harvard Pilgrim Health Care saw similar positive results with colorectal cancer screenings.  A team reduced the screening gap between groups with low health literacy and their general patient population from 11 percent to 4.1 percent in four years.

The payer also used demographic data to improve the distribution of healthy food to local communities by 87 percent in 2016.

Geospatial mapping tools can supplement the use of demographic data to target initiatives to high-risk populations.  

Through the use of geospatial data, California-based Health Net reduced postpartum care disparities by 40 percent and increased postpartum visits for African American women in Los Angeles from 17 percent to 33 percent. 

Health Net used mapping tools to identify transportation issues in their local service areas.

The payer then provided transportation and home visitation services for their members, which helped produce the gains in screenings and care access.

At UPMC Health Plan, a partnership with the US Department of Housing helped to secure permanent supportive housing for homeless individuals. The program integrates permanent supported housing, an assigned medical home, and case management/care coordination to help deliver savings of more than $6300 per year to UPMC for You Medicaid members and Special Needs Plan members.

Other payers can help financially support patients through pilot programs that help members find jobs, and retain those jobs, by addressing employment-related health factors.

CareSource in Ohio provides support systems for individuals including stress management, dependable transportation, child care, budgeting, and personal finance literacy by partnering members with life coaches.

“Addressing social and behavioral factors has the potential to increase the effectiveness of health care and associated health care dollars, thereby improving outcomes and overall health. Given the importance of SDOH, efforts are underway to account for socioeconomic factors in quality measurement,” the report concluded.

“While improvements are being made, there is more work to be done to continue to improve the quality and access to affordable care across the country, including addressing SDOH.


Sign up for our free newsletter:

Our privacy policy

no, thanks

Continue to site...