The U.S. healthcare system has historically only focused on clinical factors that affect our health.
However, research shows social determinants of health (SDOH) such as housing, education and socioeconomic status serve as a barrier to receiving proper healthcare and can have negative effects on our overall health, including higher rates of disease, poor quality of care and limited access to care. As such, healthcare organizations have begun to take initiative in addressing SDOH to promote better overall health and well-being among their members.
In order to make headway in lowering overall health costs while supporting the holistic health of a member, health plans need to overcome barriers to implementing SDOH solutions.
Identifying social determinants of health
Health plans are starting to recognize that SDOH are the foundation of providing whole-person care. Currently, the process for identifying and addressing SDOH can be reactive and is often based on claims data. In other words, health plans may not realize a member is considered high-risk or high-cost until they have visited the emergency department several times.
Health plans can lower costs and promote holistic care by conducting SDOH assessments of at-risk members and analyzing those data to fully understand a member’s clinical and nonclinical needs. From there, health plans can begin to develop a system that can leverage these type of data into their current healthcare delivery system and work toward clinical and social solutions that support holistic care.
Integrating social care into healthcare delivery
For health plans to implement an effective SDOH strategy, developing an infrastructure that integrates both clinical and social interventions should be the backbone of their plans. It’s not enough to only address clinical factors. Health plans need to take a broader approach that encompasses the myriad social factors that influence their members’ well-being.
In order to begin the process of integrating social care into the healthcare ecosystem, health plans need to evaluate the specific SDOH needs of its members, such as where they live, whether they have access to transportation, if they are experiencing food insecurity, etc.
Once those factors have been identified, health plans can then work to identify and recruit the appropriate social service and community-based organizations in their members’ neighborhoods. These organizations will be the front-line supporters that will be able to help members address their nonclinical needs, such as bridging the gap in transportation issues or improving an issue of food insecurity. Once this network has been set up, health plans can oversee contracting, determine payment structures and, finally, set up an infrastructure so that all components can work together seamlessly and holistically.
Building an accountable and effective network
Although there are health plans that are currently addressing some of the major social needs of its members, such as housing or transportation, some health plans cannot cover the needs of all members because they do not have the necessary infrastructure in place to do so.
In fact, health plans that try to solve issues related to SDOH on their own often run into issues such as difficulty in prioritizing interventions or advocating for appropriate resources, inaccurate resource information, lack of accountability, fragmented coordination processes and lack of transparency.
Health plans can ensure they have a thorough end-to-end infrastructure for their SDOH strategy—which includes relevant social service organizations—if they are selective in which SDOH partners they work with. For instance, health plans should choose organizations that have experience in gathering and analyzing data, recruiting social service organizations, managing the contracting process, implementing an infrastructure that supports seamless coordination, developing technology systems and measuring the impact of social interventions.
When health plans form beneficial relationships with trusted SDOH partners, they are able to more fully address the social needs of all members and promote more well-rounded health for all.
Manik Bhat is the founder and CEO of Healthify.