Industry Voices—How one payer is meeting patients where they are to address the social determinants

A person attending a nutrition class
In order to make progress towards improving outcomes, the health care industry must be willing to open its doors to where our patients live. (kitzcorner/Shutterstock

For many people, achieving and sustaining improved health and wellbeing requires a multi-faceted support system that goes beyond episodic care or chronic disease management.

Factors such as where a person lives and whether or not they have access to safe housing, transportation or healthy food resources can have a significant impact on their health and the costs encountered throughout the health care system.

In order to make meaningful progress towards both improving outcomes and the costs associated with them, those of us in the health care industry must be willing to open our doors to where our patients live, work with them to discover what barriers may stand in their way of getting the care they need, and connect them to services that will directly impact, and in many cases, immediately improve their situation and their health.

New Whitepaper

CMS Doubles Down on CAHPS and Raises the Bar on Member Experience

A new CMS final rule will double the impact of CAHPS and member experience on a Medicare plan’s overall Star Rating. Learn more and discover how to exceed member expectations and improve Star Ratings in this new whitepaper.

Cutting costs and improving outcomes

We know that behavioral, social and environmental factors are responsible for more than half of a person’s health and that these factors have a direct correlation to our nation’s disproportionate health care spending. Helping people to engage in and sustain healthy behaviors at home, in the community and at work reduces costs across the entire system—for patients, payers and practitioners.

At EmblemHealth, this is where Neighborhood Care comes in. We established physical retail locations throughout our coverage area that have been designed to improve the experience and health of our members and the communities in which they live.

Locations are staffed with customer care navigators who have deep roots and close ties in their respective communities, and we’ve implemented specific staff training around social determinants of health to ensure that we approach each patient that walks through our doors with respect and an openness to address their individual needs.

RELATED: Healthcare must look inward to better address social determinants of health, Berwick says

At Neighborhood Care, we offer our members and neighbors a range of in-person services, from free health and wellness classes and expert assistance in navigating the complexities of healthcare, to nutrition seminars, lifestyle coaching, group support sessions and more. We also create cornerstone health and wellness programming that focuses on conditions that greatly affect our population, which include pre-diabetes, diabetes, obesity and pregnancy (pre-natal and post-natal care).

Finally, we work to co-locate Neighborhood Care with our partner AdvantageCare Physicians (ACPNY), one of New York's largest primary and specialty care practices, in order to bring medical professionals and clinical experts under the same roof as social workers and nutritionists. This set-up allows us to accelerate and ease access to care when members need it and ensure they are getting their relevant age-based vaccines, screenings and checkups, consistent with our broader emphasis on providing care that is preventative, medically appropriate and cost-effective.

Measuring the effectiveness of Neighborhood Care offerings

Tailoring our Neighborhood Care offerings to the specific needs of the community is key, and actively soliciting feedback is an important means of evaluating the effectiveness of our programming. We constantly engage with our partners within the broader EmblemHealth organization and the community at large to ensure that we can simultaneously offer our cornerstone programming while piloting new services.

Neighborhood Care measures success with several key metrics focused on member and patient retention, engagement and satisfaction, such as the number of individuals served, the attendance of our program offerings, and the resolution of customer service inquiries.

We also partner closely with our care management team and AdvantageCare Physicians’ Care Teams so that we may play an active role in a member’s care plan, which means that we will also look at metrics related to plan adherence, including whether or not a member gets regular wellness visits, is taking their medication or reaching their target weight.

RELATED: Leana Wen—In Baltimore, where you live could knock 20 years off your life

We’ve consistently seen a positive impact on the health outcomes, patient experience, quality and overall cost of care for the populations we serve. In particular, the changes we’ve seen related to diet and food habits are really encouraging. As we’ve introduced more resources dedicated to healthy eating, we continue to receive positive feedback and see increased demand across our locations.

And while we know that a community and its population are not static, we do our best to listen, be flexible and adjust as necessary. When a region of the city does experience a demographic shift, we work to understand what new language and programming needs might exist.

The future of community-based care

Here in New York, there are reports that the Cuomo administration wants to allow Medicaid Managed Care Organizations to count preventive services that try to improve a patient’s social surroundings as a medical expense instead of an administrative expense.

As health care leaders continue to build more social determinant-focused programming that are relevant for Medicaid and other members, changes in administrative classifications such as these stand to play an important role in opening the doors for the industry to receive additional resources that can be utilized to boost community-based wellness initiatives.

RELATED: CVS announces new initiatives targeting the social determinants of health

At EmblemHealth, we’re committed to setting a new standard for access to comprehensive health care services and addressing the complex and challenging social determinants of health. It is our belief that keeping people healthy starts by partnering with providers and community resources to deliver better care and better outcomes at a lower cost, in their own communities.

Understanding the real, everyday health and wellness needs of our patients requires being the eyes and ears in their home communities—and it requires a commitment to collaborate from the entire health care industry.

Beth Leonard is the Chief Marketing and Communications Officer for EmblemHealth and AdvantageCare Physicians. She oversees the marketing, internal and external communications, community care strategy, grassroots, digital and consumer experience for both organizations.

Suggested Articles

House Democrats slammed drug companies Teva and Celgene for consistent price hikes on vital drugs during a hearing Wednesday.

Insurance giant Anthem has reached a settlement with a group of State Attorney Generals over the historic 2015 hack into its computer network.

UnitedHealth Group is jumping into the online pharmacy space with the acquisition of startup DivvyDose, according to a media report.