Thu, 08/02/2018

According to the World Economic Forum, social and environmental risk factors account for 20% of health outcomes. Social determinants of health include the conditions of the places where people live, learn, work, and play. These conditions can affect a variety of health risks and outcomes. Unstable housing, low income, unsafe neighborhoods, and substandard education are some of the major factors that can influence patient health.

Factors Influencing Health Outcomes

Social risk factors increase the danger of a future disease burden, particularly in the lower income populations. Incorporating these social determinants into patient EHRs, and having them become part of the workflow may improve individual and population health. Once these social determinants are mapped, they provide the key to developing personalized care.

Collection will be exacerbated if there are limitations on data sources and challenges to the workflow. Collecting social determinants of health is a challenge to begin with, considering they are not commonly found in claims or medical records. Mostly, this information is found in coded and unstructured EHR data.

A recent report by the National Academies of Science, Engineering, and Medicine (NASEM) calls out five measured domains of social risk that create bias in the programs. The domains included:

  1. Socioeconomic position, such as income, education, dual eligibility, wealth, and occupations
  2. Race, ethnicity, and cultural context
  3. Gender, including both normative and non-normative gender identities
  4. Social relationships
  5. Residential and community context, such as neighborhood deprivation, urbanicity, and housing

Some of the recommended steps to address and modify some of these social components are:

  1. Add screening for social determinants into healthcare workflow
  2. Identify social risk factors at the point-of-care
  3. Facilitate non-medical interventions to address social risk factors

For example, Humana, through their philanthropic arm the Humana Foundation, is making long term investments into community programs that address social determinants of health. This is in alignment with their “Bold Goal” program which aims to improve the health of communities they serve 20 percent by the year 2020. The Bold Goal program uses a CDC measure called “Healthy Days,” which measures individual mental and physical characteristics to determine a person’s health status within a given thirty-day period.

A “healthy day” indicates a beneficiary had positive physical and mental health measures such as blood pressure, blood-glucose level, emotional health, and social support. To make a greater impact, Humana is trying to address upstream social determinants of health – asset and financial insecurity, food insecurity, housing instability, limited English proficiency, social isolation, and inadequate emotional support – so fewer people develop chronic conditions in the first place. Humana’s older beneficiaries that had limited access to healthy food options were 50% more likely to develop diabetes, 14% more likely to experience higher blood pressure, and had a 60% higher chance of having a heart attack.

Social isolation is a significant social determinant of health for elderly beneficiaries. Humana’s Medicare members living in social isolation had a 26% higher likelihood of dying prematurely than members who lived with friends or family. These socially isolated members also had double the risk of Alzheimer’s disease.

The Bold Goal program includes a free diabetes resource guide to educate members on personal wellness, a publicly available resource directory, wellness programs like suicide prevention outreach, a partnership between San Antonio food bank and MCCI Medical group, YMCA educational programs, transportation for individuals with respiratory conditions, a COPD pilot initiative to assess functional status of elderly members living with COPD, and a partnership with Louisville Metro Housing Authority to make housing smoke-free.

The Bold Goal 2018 progress report reveals positive health outcomes for elderly beneficiaries with diabetes, heart disease, respiratory conditions, mental health issues, and other chronic diseases. Humana members in the San Antonio Bold Goal Community experienced a 3.5% improvement in the number of reported Healthy Days. Fifty-nine percent of Humana Medicare beneficiaries with depression maintained antidepressant adherence, which is 4% higher than the national average.

Similarly, HealthConnections, a program from WellCare Health Plans, focuses on addressing the socioeconomic needs of vulnerable patients by referring beneficiaries to community services, such as transportation to appointments or help paying for basic utility services. Researchers observed an additional 10% reduction in care costs for those who had their social needs met through the HealthConnections program compared to those who did not.

Another great example is Methodist Healthcare Ministries of South Texas and the state’s health information exchange (HIE) HASA partnering to launch a pilot project for linking social determinants of health data to patient EHRs. As part of the partnership, HASA will use $175,000 grant from Methodist Healthcare Ministries to integrate social determinant data into its clinical data repository through a cloud-based app.  The pilot program aims to give physicians a more holistic view of patient health that includes any clinical, social, and behavioral risks. The program aims to equip care managers with the information to connect patients with a variety of community services able to reduce the need for emergency visits.

These results reinforce the need for policies that encourage organizations to accept financial responsibility for addressing social determinants of health through nonmedical interventions. By collaborating with community stakeholders, payers can play a significant role in bringing value to their beneficiaries.  The community-based initiatives not only improve the quality and experience of members in the community but also raises a payer’s positive profile.

For more information on creating innovative solutions for healthcare members, please visit our payer solutions page.