Social determinants of health (SDOH) has been a major buzzword within the industry over the last decade – and for good reason. These social and economic factors – such as level of education, health behaviors, physical environment, and more – influence more than 80% of an individual’s health outcomes, proving to have an even greater impact than clinical factors alone.
Given this, payers have begun to recognize the critical value in addressing SDOH within their beneficiary populations, both from a member health and cost perspective.
The COVID-19 pandemic further revealed the significant implications of SDOH on the health of certain populations. And as a result, the Centers for Medicare and Medicaid Services (CMS) and state Medicaid programs are driving greater investment efforts into the innovations and solution initiatives surrounding SDOH. For example, Medicaid Managed Care Organization (MCOs) may be better equipped to address members’ social determinants of health and health equity compared to payers who use fee-for-service models. References to SDOH are central to many requirements for MCOs, most notably when pertaining to population health management strategy, health equities, care coordination, and value-based payment.
Simply put, by combining aggregate clinical data with SDOH observations, comparative analysis can reveal which societal factors correlate with conditions or adverse health events. With such insights, the escalation of a member’s health condition or an adverse health event can be prevented, thus reducing costs.
For example, a homecare aide may notice a patient’s wheelchair ramp is in need of immediate repairs and can report the situation to a supervisor, helping to ensure the dangerous ramp is fixed before the patient becomes injured when using it. Similarly, a patient may mention to a homecare worker that he or she has no transportation options and will be unable to make a scheduled doctor’s appointment the following day. To avoid a missed medical visit, an aide can share the information with someone who is in a position to remedy the situation and ensure the appointment is kept.
Today, with more focus on value-based care models, there is a stronger incentive to collect SDOH data. Historically speaking, finding the best solutions to bring together both clinical and SDOH data to gain a holistic view of a member or population – and to share that data amongst key stakeholders – has been a weak spot our industry must address.
So, what exactly is the key to success and how is success defined? Being able to connect the full network of stakeholders is the key – from members, providers, and payers, to home healthcare workers, community based support organizations, government entities, and mental health providers – and ensuring they have the right data to achieve a comprehensive view of the care and other services individuals may need. The success achieved from connecting the right stakeholders to the right data can be measured by the improvement in member outcomes through the combined adoption of value-based care and person-centered goals.
In early 2022, HHAeXchange launched our latest solution, Care Insights for Payers, to enable payers to leverage caregivers’ visit frequency with members to capture change in condition alerts and SDOH observations, creating additional visibility at the member, risk cohort, and population levels. With the solution, which integrates directly with care-intervention programs, a caregiver’s frequent engagement with members is leveraged to improve the quality of care through early identification and mitigation of risk factors, thus reducing adverse and costly events – including emergency room visits, hospital admissions, and skilled nursing facility admissions.
Since launch, the tool has helped customers reduce overall time to identify risks, as they are better equipped to get more frequent insights into member health without the administrative burdens. The tool also makes the process more manageable so teams are not inundated and can better handle alerts and take care of potential escalations.
All in all, the ability to combine and analyze clinical data and SDOH observations, and having purpose-built technology and tools that give all stakeholders insights into the societal factors that correlate with specific conditions or adverse health events, are more important than ever.
With a more detailed, 360-degree view of all factors impacting members’ health, providers and payers can proactively address issues to reduce adverse and costly events and ensure members have the chance to lead healthier lives.
To learn more about our Care Insights solution and how you can empower your organization with value-based initiatives and actionable insights, content a member of our team or request a demo today.
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