Building Networks to Address Social Determinants of Health - Cover

Building Networks to Address Social Determinants of Health

When it comes to improving patient care, social determinants of health (SDOH) solutions continue to be top of mind as the pandemic continues to grip the world. Healthcare organizations all over the US continue to grapple with ways to extend the care of patients beyond the walls of clinics and hospitals.

I talked with Matt Sabbatino, Managing Director in L.E.K. Consulting’s Healthcare Services Practice, about what has happened with SDOH services during the pandemic and what the outlook is for the future.

Sharlin: Why is addressing the role of SDOH important to patient care, and how has healthcare addressed it? 

Matt: For almost 10 years, L.E.K. has been helping clients, including fortune 500 health plans and large health systems, think through SDOH.

SDOH has been widely talked about because science and evidence both clearly show that these factors impact a person's health. Therefore, these factors also impact people’s medical claims, how much they utilize the medical system, and their total cost of care.

Historically, much of the focus regarding SDOH has been on Medicaid or the lower-income populations. This is because, unfortunately, they typically have more issues around social determinants than the commercial population who is generally working and has employer-sponsored health coverage.

A lot of SDOH effort focuses on the most basic needs like supportive housing, nutrition, and transportation. There are also other SDOH services that focus on helping people with banking and financial services. Lower-income populations typically don't or can’t bank or might even be afraid to bank. Some solutions also help with job placement services. Behavioral health is also an important part of SDOH.

Sharlin: How have the needs surrounding SDOH evolved through the pandemic?

Matt: We are all aware that during the pandemic many people have lost jobs. This has shifted people who may have had commercial insurance of some form, either through their employer or on the ACA exchange, onto the Medicaid rolls. The states also stopped redeterminations in Medicaid, and that resulted in more swollen Medicaid rolls without the normal process of churn and disenrollment. The pandemic ultimately created an additional need for SDOH services within a population that wouldn't have likely been there otherwise.

Because of this circumstance, social needs are even more acute right now because people have been reluctant to go out of their house and seek care, and this may continue for longer because of the Delta variant. At the same time, these patients probably need more services compared to what they needed prior to the pandemic given all the stress it is creating.

Sharlin: How can the industry meet this challenge, and how can technology help?

Matt: By focusing on health plans, we can make sure we're reaching people who need these supportive services by connecting them with the community-based organizations that provide these services. Right now, the health plans are trying to figure out ways to make sure they can connect people with the community-based organizations (CBOs) that primarily provide these social services.

Some health plans deliver some SDOH services on their own, but they are hit or miss. Unless there is a waiver population in a state where you can bill for things like supportive housing and nutrition, health plans already have tight margins and may not be able to directly provide SDOH services without reimbursement of some form. They don't have much room to essentially donate these services. Some health plans do it anyway to do the right thing. And they might get some PR out of it, but what they do on their own isn't robust enough to meet their members' needs. For this reason, there is a real need for the local CBOs to secure their own funding and deliver these services.

That's where technology comes in. Health plans can use platforms like Aunt Bertha, Signify Health, and other third-party platforms to connect members with the CBOs. Some solutions, for example, enable viewing rights of different parties so the health plan, care providers, CBOs, and patients can see relevant information to them within HIPAA requirements.

Tools like this can be very helpful in “connecting the dots” and integrating care. Before similar solutions were available, everything was so disconnected. Now, a doctor might note that their patient misses appointments because of a transportation issue and recommend a CBO to help. In the past, if the patient didn’t act on contacting that organization, this likely would have gone nowhere. But with digital solutions, perhaps the health plan sees the information, does something about it, and closes the loop. A lot of work was being put into approaches like this before, but the pandemic has put more emphasis at the health plan level and on other risk-bearing entities like PCP groups. I'm hoping the effort continues.

Connecting their members with social services and support is a big deal to the health plans we work with, particularly in terms of Medicaid and Medicare. If the health plans don't already have one of these technology platforms signed up, many are seriously considering one.

But no third party has really organized those community-based organizations into broad, national networks, though some have started. This is where there is a huge opportunity for health plans to come in. They already build networks of providers and provide access to care. This is just a different type of provider.

Health plans could build some of these networks, put processes in place, and leverage their network management expertise. Technology can continue to help them with that. Technology solutions can give health plans not only a prebuilt network they can leverage to provide services but also a tool to add to that network.

Sharlin: So how would you advise a technology company or even just a care provider that's looking to innovate in this space?

Matt: Think about the real needs in the space and try to address them. For example, there is a real need for a solution that patients can navigate on their own. I know not everybody has internet access, but most people have a smartphone. Maybe the solution isn’t an app but is something that can be deployed on a smartphone or other devices. It needs to be easily found, whether that's through a health plan or a provider website. It should also quickly connect patients with services they think they need.

The second piece to think about is creating a platform that provides as much interconnectivity as possible within the rules and regulations between the CBOs, healthcare providers, health plans, and patients.

We still need a highly connected digital ecosystem so that we can close the loop on these SDOH encounters. There needs to be some platform where different constituencies can log in and check and see what's happening, make connections, and close the loop. As I mentioned, networks are the key part of this work. During COVID-19, CBOs have been busier than ever, so it has become more and more important to have more than just the five numbers on the index card in the drawer of the care navigator or PCP. People need to have access to the broader network. Ultimately, the work is about making sure patients/members get the services they need to improve their health and wellness; total cost of care savings should result.

Photo credit: Tartila, Adobe Stock