Technology can help scale social determinants of health. But to be effective, we must first understand the people with whom we wish to engage.
Authored by Jane Sarasohn-Kahn, MA, MHSA
There are many voices in the healthcare value chain. Physicians and nurses are the frontlines of service providers. Information technologists are responsible for managing the growing velocity, volume and variety—as well as the growing threats of cybersecurity. Health plan sponsors, such as employers and unions, represent a formidable customer voice as payers and managers of precious human capital—their employees.
There’s another payer in this health ecosystem, and it’s the patient. It’s crucial to listen to, engage with and talk to patients—and to consider them consumers.
Conversations with patients as both consumers and payers are pivotal for unearthing insights that can better inform treatment and care plans, optimize coverage options, and, ultimately, build trust between people and the healthcare system.
Here’s a real-world example from the Medecision Liberator Boot Camp 2019 in January that further informed my thinking. Medecision convened its digital health team (known as “Liberators”) and several clients who provided external perspectives on healthcare industry trends, technology developments and personal stories on how the system is and is not working for patients.
We listened to an anecdote about an older health plan enrollee who dialed her plan’s call center to ask a question. While on the phone, the operator began a dialogue with the caller about her daily living activities. However, the script wasn’t one that ticked off the usual list of questions such as, “Do you regularly eat or cook for yourself?” “Do you feel lonely?” or “Do you regularly remember to take your medicine as prescribed?”
Instead, the question that sparked a true and authentic conversation was: “What do you like to do for fun?”
The member said, “I like to go to bingo.”
This sparked an honest conversation about the member’s love of the game. But it also gave the caller an opportunity to express frustration that she couldn’t actually get to bingo games on a regular basis due to a lack of consistent transportation.
Transportation is one of the key social determinants of health (SDoH). Asking the caller what she liked to do for fun helped identify a problem that was truly important to the person.
The conversation then led the call center representative to ask, “What do you like to eat when you’re playing bingo?”
“Pretzels or chips—salty things,” the plan member confessed.
“Salty snacks,” the call center representative repeated, making a detailed note in the client’s record. The information on what she was eating was important because the client was dealing with a heart condition where too much sodium represented a risk factor in managing heart failure, causing water retention and generally exacerbating cardiac issues.
Talking about car rides and potato chips—that’s getting to the true voice of the customer.
Valuing a Patient’s Voice
So, why is this story important?
Capturing the consumer’s authentic voice underscores the impact of partnering with healthcare’s most important consumer—the individual who makes daily decisions that bolster or diminish health, where she lives, works, plays, prays, learns and shops.
Engaging, inspiring and helping people sustain healthcare activation takes a village beyond the initial call center conversation. In the above scenario, the conversation revealed at least two risk factors: inconsistent transportation and poor nutrition (which health providers have begun to address, as the Geisinger Fresh Food Farmacy has shown).
We see the emergence of Lyft, Uber and medical transport start-ups addressing the transportation gap and helping people get to doctor’s appointments. But transportation can also be used to fill the chasm of social isolation and loneliness that can negatively impact cognition and mental health and lead to chronic conditions. Robert Wood Johnson’s research has pointed out the many dimensions of health impacted by the SDoH of transportation. And Meals on Wheels has begun to be deployed beyond the delivery of nutritious food to also deliver social and health “check-ins” with clients in their homes.
As for the problem of too many salty snacks, think about the role of meal-plan subscriptions that urge people to cook more at home. The infrastructure is in place to expand this concept for food as medicine. My work in Europe has shown me how this scales across the EU. For example, Danone (parent company of Dannon) has a portfolio of nutrition businesses beyond the yogurt we know in the U.S. In Europe, Danone covers the continuum of nutrition from prenatal care to aging wellness.
In the U.S., consider Best Buy’s acquisition of GreatCall. Best Buy, recognizing the challenges of bricks-and-mortar retail for consumer electronics, brought GreatCall into its portfolio of businesses to improve its ability to serve people aging at home. Bolstered by the Internet of Things (IoT) and connected devices that are both clinical (like activity trackers, blood pressure monitors, and glucometers) and home appliances (like smart refrigerators), Best Buy is seeking to fill a gap in the marketplace.
Forging a Smarter Health Community
Technology can help scale social determinants in constructive ways. But to effectively do so, we shouldn’t first focus on the technology itself. We must first understand people based on their preferences, values and concerns beyond the typical checklist of daily living activities. What’s important to Mrs. Jones might not be relevant to Sra. Delgado. That Mr. Smith believes he must play a daily round of nine holes of golf to manage his mood and blood pressure may be of no concern to Mr. Romero, whose happiness depends on crafting home brews and hosting weekly potluck suppers with friends in his senior living community.
In early June 2019, JAMA published a Viewpoint essay, Building Trust in Health Systems to Eliminate Health Disparities. The physicians who wrote the piece asserted that, “Eventual transition to systems that reward good health outcomes will require health systems to proactively partner with patient populations and communities to eliminate health disparities as a shared value.”
As I discuss in my new book HealthConsuming: From Health Consumer to Health Citizen, grocery stores, YMCAs, colleges and barbershops are community touchpoints that serve local residents’ health goals. Patients-as-consumers already interface with these organizations on their own terms in daily lives.
A recently published report by Deloitte on Smart Health Communities and the Future of Health points out that, traditionally, care was delivered in the community until the industrialization of the U.S. health system grew out of health policy changes during World War II.
Today, “the pendulum is swinging back,” Deloitte notes. A so-called “smart health community” is emerging that may provide the ability for consumers to proactively manage their health, foster a sense of belonging, employ digital technology and behavioral science, use data to improve outcomes, and create new ecosystems to support health where they live.
The artful, well-designed use of digital tools can indeed help to scale social and clinical care to people’s daily lives. But that patient’s life flows and goals must always be central in the design and deployment of that technology.