Historically, the incentives built into fee-for-service payment models actually encouraged providers to ignore the social determinants of health (SDH) that impact health outcomes.
For example, providers were financially rewarded when “frequent flyers” were readmitted, and it was easy to rationalize such factors as “out of scope.” Ignoring vulnerable populations’ socioeconomic factors may have been good for business in the past, but looking to the future, providers are now being forced to consider SDH’s impact.
Growth in bundled and risk-based payment models is driving this change by focusing on health outcomes and cost of care, shining a spotlight on the impact of SDH. Newly enthusiastic providers are committing resources to community health strategies but often without a coherent framework and focus on ROI. Instead of broadly defined population health initiatives, providers must take a targeted, outcomes-focused approach.
To move the needle on outcomes and costs, providers need to overcome some common challenges, including an inadequate understanding of at-risk populations and socioeconomic determinants; provider-centric solutions versus ones focused on target populations’ needs; underengagement of community resources; and inadequate alignment across stakeholder groups.
Rather than work within old systems’ organizational constraints, providers and community partners need to develop new ways of thinking, innovative delivery models and requisite competencies. This requires strong leadership, commitment and a systematic process that examines six tactics:
- Diagnose needs and set goals. Using quantitative and qualitative research, providers should identify and prioritize contributors to high costs and poor outcomes. Inputs include clinical, cost, and public sector data, plus insights from key informants who understand target populations’ needs. Next, providers and community partners should perform an objective gap analysis to understand the technology, process, behavioral and cultural elements that need to be addressed, including those shared by target populations in focus groups or field interviews. After this point, program details can be developed.
- Structure-focused solutions. Providers will need help from community coalitions to design and develop solutions. Building a charter that outlines the mission, goals, roles, and key accountabilities is critical. Reasonable consensus must be developed on how outcomes and key process measures are tracked, plus how this information is reported and disseminated. Progress against defined metrics should be evaluated regularly to identify improvement opportunities.
- Avoid overinvesting. Many SDH factors can be addressed without large technology and analytic investments, so providers should resist unnecessary infrastructure. Less complex solutions are often the best option to quickly achieve cost reduction and improve outcomes, plus they allow for greater flexibility when course corrections are needed.
- Actively communicate. Communications strategies that build program awareness among target populations are essential. In terms of how and where these are delivered, venues can range from churches and barbershops to ERs and food pantries.
Beyond beneficiaries, providers and community partners must be visible, passionate communicators of the program. Leadership communication is particularly important during the early phases of development and deployment, and ongoing communication reinforces organizational commitment.
- Provide incentives. Rewards are important in driving behavioral change. These can be formal—like issuing rewards cards for making healthy food purchases or holding diploma presentations for graduates of health education programs—or informal, such as offering simple praise.
- Create mechanisms for change. To shape and sustain change, providers should use every opportunity to share the story and celebrate success. Capstone celebration events to mark milestones reinforce positive behavior, as do stories about the positive impact the program has had on a person’s life. Programs should also incorporate mechanisms for continuous learning and improvement.
The six areas outlined above are key to creating a sustainable model that enables providers to focus on SDH factors with the biggest economic impact. Over time, providers can leverage their learnings to further improve bottom lines and enhance their competitive position with payers and employers. For responsible healthcare executives, addressing SDH is more than a moral imperative, it’s a business imperative.