Without a doubt, social determinants of health impact health outcomes. Recent research suggests medical care accounts for only 10-20 percent of health outcomes while the other 80-90 percent are attributed to demographic, environment and socioeconomic factors. At the same time, studies have shown that most patients have at least one social determinant of health (SDoH) challenge.
Given the prevalence and profound impact social determinants have on health outcomes, it makes perfect sense that addressing a member’s housing, transportation and food needs reduces health spending. Payers have led the way with pilots and research studies demonstrating the effectiveness of managing patient social determinants:
- A 2016 study by the Robert Wood Johnson Foundation reported a 17 percent decrease in emergency department use, a 26 percent reduction in emergency spending, a 53 percent decrease in inpatient spending and a 23 percent decrease in outpatient spending as the result of referring 33,000 people to 106,000 community-based programs and services.
- Research conducted by WellCare Health Plans and the University of South Florida College of Public Health found connecting members with social services to address SDoH generated a double-digit reduction in healthcare spending. In addition, patients are more likely to be engaged in their health when social determinant barriers are addressed. Specifically, they were:
- 6.9 times more likely to have a better adult BMI score
- 2.8 times more likely to have a better medication assessment score
- 2.3 times more likely to have a better colorectal cancer screen
- 1.7 times more likely to schedule and attend their annual PCP visit.
- Geisinger Health System’s Fresh Food Farmacy program provides 15 hours of education about diabetes and healthier living, followed by 10 free nutritious meals a week for diabetics and their families. It costs $2,400 per patient per year to operate the program, and early research shows an 80 percent reduction in overall health costs: from an average of $240,000 per diabetic member per year to $48,000.
Social Determinants of Health in Action
With 59 percent of healthcare payments expected to be within value-based care models by 2020, payers are increasingly moving from SDoH pilots to addressing member social determinant challenges at the population level.
A combination of publicly-available county and zip code data and member-level social determinant information can dramatically improve the effectiveness of care planning for members, if made readily available to care managers. For example, the payer care manager responsible for a member with congestive heart failure, hypertension and type 2 diabetes, and social determinant indicators for housing and transportation could leverage that information, drilling into the patient record to see information such as:
- The member moved three times in the past 12 months,
- There is no known licensed driver in the household,
- The closest in-network pharmacy is nearly a mile away from the member’s current residence.
Social determinant information presented in this manner suggests transportation is the reason the member has not recently filled their prescriptions. In this case, the payer care manager would contact them to confirm they do not have access to a car and the distance to the nearest bus stop. Within the patient record, the care manager could arrange for medications to be sent to the patient’s home as well as create a referral to a social services organization that provides transportation to physician visits.
Similarly, care managers can identify and address populations or subpopulations with social determinant gaps. For example, an employer with a high prevalence of diabetes and prediabetes among employees and dependents can work with a payer care manager to determine if social determinant barriers such as hunger, access to healthy food options and/or the absence of parks, playgrounds and sidewalks are adversely impacting employees’ ability to embrace the kind of lifestyle changes needed to manage diabetes and prediabetes. The employer may also choose to add healthier options in the company cafeteria, replace vending machines with fruit bowls and install fitness equipment in the workplace.
For more information, download Geneia’s white paper, Social Determinants of Health: From Insights to Action