Research shows that social determinants of health (SDOH)—such as housing, transportation, access to healthy food and more—are linked to patient outcomes. Managed care organizations are partnering with community and social support providers to address SDOH to deliver better health outcomes.

Healthcare budgets remain tight, and pressure to improve population health outcomes continues. In this environment, healthcare providers and organizations are focused on getting the biggest bang for the healthcare buck. Increasingly, managed care organizations (MCOs) are determining that focusing on social determinants of health (SDOH) may have more far-reaching effects than simply spending more on pharmaceuticals and medical procedures.

Think about it: It’s difficult to be healthy if you don’t have clean air, clean water, nutritious food, and a safe, warm place to live. And good health can quickly deteriorate when an individual is unemployed, facing housing insecurity, unable to access healthy food choices, or stressed about finances or safety.

“Providers have been treating people’s medical condition over and over again, but then sending them back into the same environment with small to no improvements,” says Trina Milling-Hawkins, Vice President of Government Solutions Development at Medecision. “Healthcare is ready to start addressing the whole person, inclusive of their social barriers. You can’t really attack the medical side if you’re not truly sensitive to the environment that is impacting their medical conditions.”

The concept of addressing how environmental factors affect individuals’ health is not new; however, “it’s now time for MCOs to start managing their members’ social barriers alongside their medical care,” Milling-Hawkins says. “This will require MCOs to develop new operational procedures, staffing models and payment systems to support non-clinical data and data exchanges between community agencies.”

Recent research shows that countries that spend more on social programs such as housing, senior programs, unemployment and food security have better health outcomes than those that spend more on healthcare. And some new state and federal laws now require or encourage health plans to partner with community and social support providers to address SDOH.

Prioritizing Social Factors

A number of MCOs and health plan providers are implementing their own approaches to the problems that contribute to members’ health concerns. For instance, Anthem Blue Cross and Blue Shield in Indiana has teamed up with a local food bank to help solve hunger among senior adults in 21 counties. In 2019, with funding from Anthem, the food bank will host 120 mobile food pantries for seniors, providing them with nutritious food as well as information about Anthem’s Medicare plan options.

In several Midwestern states, Anthem offers home-delivered meals to some Medicare Advantage plan participants after they are discharged from the hospital. The program helps combat weight loss and poor nutrition, which have contributed to hospital readmissions in the community.

And in Chicago and Dallas, Health Care Services Corporation (HCSC) and Blue Cross Blue Shield Institute have launched a low-cost meal delivery service to provide healthy, nutritious meals to people who don’t have adequate access to fresh foods. The service is available to anyone who lives in the targeted ZIP codes, in an effort to reduce avoidable emergency room visits and hospitalizations.

“Food deserts are one of the key social determinants of health impacting millions of Americans,” Manika Turnbull, vice president and community health and economic impact officer at HCSC, told Healthpayer Intelligence. “With this program, we are meeting people where they live to provide access, affordable pricing and education that can influence healthy behaviors, reduce health disparities and improve their quality of life.”

In addition to hunger and nutrition, MCOs are addressing other SDOH such as adequate housing. The Aetna-administered Mercy Maricopa Integrated Care Medicaid managed care plan in Arizona runs a Permanent Supportive Housing program, which provides housing subsidies for members with mental illness diagnoses.

And UnitedHealthcare recently funded a 65-unit housing center in Los Angeles, aimed at reducing homelessness. It’s one of 80 affordable housing communities across the country that the payer has helped fund in an effort to remove social barriers to better health. In one state, emergency room admissions dropped 60% and total cost of care of cut in half for people who enrolled in a housing program, according to UnitedHealthcare’s Medicaid data.

In addition to launching their own programs to address SDOH, healthcare payers and organizations are also funding grants and providing other support for community and nonprofit organizations that target issues such as homelessness, hunger, transportation and childcare.

Going Local

Identifying and partnering with local organizations is one of the most effective ways that MCOs can address SDOH. That’s partly because these organizations may be more in tune to the needs of the local community. It also allows healthcare organizations to share the cost of needed programs with existing agencies.

“Health plans and community organizations are trying to determine how to fund and staff for an increasing number of members being navigated to community resources,” Milling-Hawkins says. “There may be some opportunity to leverage existing under-utilized government funding in communities, but ultimately there should be conversations that support new funding mechanisms to support SDOH.”

That familiarity with the local community also helps ensure that payers are working to address the most important needs. In some areas, inadequate access to healthy food or transportation may be the biggest threats, while in others, polluted water or a high rate of illegal drug use may be more pressing.

“You have to drill down and understand the demographics of your community by ZIP code—not just by state or county,” Milling-Hawkins says. “Be aware of the food pantries and social service programs available there, especially if you’re partnering with different community resources in different areas. It’s important for an MCO to be as flexible as possible and not treat everyone as a one-size-fits-all.”

When navigating and making referrals to community agencies, healthcare organizations need to develop a process for verifying that their members received services from those providers, Milling-Hawkins says. “Come up with a process to ensure the case managers in the health plan have a good holistic visual of the person receiving the services and collect data to measure outcomes.”

The Bottom Line

As MCOs increase their focus on improving the social issues that negatively affect their populations, they can see improved health outcomes and stronger bottom lines.

“A person’s social environment may drive up medical costs if not addressed appropriately. Focusing on SDOH will better position you to understand the whole person and better manage the medical expenses that directly tie to the member’s physical and mental condition,” Milling-Hawkins says. “You should see cost savings tied to reducing readmissions, emergency care and improving preventive care.”


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