There are numerous predictions about the effects of the coronavirus pandemic on mental health and addictive disorders, particularly the effects of social isolation and economic insecurity (The Coronavirus Pandemic May Bend The Demand For Behavioral Health Services and Looking Ahead—Addiction Treatment In The Post-Crisis Recovery). We already know that consumers who report frequent feelings of loneliness suffer higher rates of mortality, depression, and cognitive decline (see Social Disconnectedness, Perceived Isolation, And Health Among Older Adults, Social Isolation Linked To Higher Risk Of Death and Is Loneliness The Overlooked Social Determinant?).
The initial statistics confirm the predictions. Consider that the Disaster Distress Helpline from The Substance Abuse and Mental Health Services Administration has seen a 1,017% increase in calls (see The Health 202: Texts To Federal Government Mental Health Hotline Up Roughly 1,000 Percent). The 2018 National Health Interview Survey compared U.S. adult internet users in 2018 to those in 2020 (see Mental Distress Among U.S. Adults During The COVID-19 Pandemic) and found that they were eight times more likely to fit criteria for serious mental illness (27.7% vs. 3.4%) and three times more likely to fit criteria for moderate or serious mental illness (70.4% vs. 22.0%).
But we have yet to try to quantify the effect of the shifting need for social supports on health care resource needs in the post-crisis period. We already know that 70% of health care spending is attributable to environmental and lifestyle factors with the remaining 30% due to genetics and health care service access and quality (see New Future For Behavioral Health: Using Public Health Models To Manage Population Health and Moving Beyond The 10% To Be A ‘High Value’ Organization).
The high and likely long-term unemployment rates caused by the crisis are likely to exacerbate the impact of social determinants—environment and lifestyle—on health resource use. The U.S. is close to reaching the highest unemployment rate it has ever seen (see Highest Unemployment Rate On Record)—projected at 47 million people (see Coronavirus Job Losses Could Total 47 Million, Unemployment Rate May Hit 32%, Fed Estimates). Previous research has documented that low-income consumers are high utilizers of acute care, and have more preventable hospitalizations, higher readmission rates, higher rates of obesity, and lack access to preventative care (see Poverty Really Does Matter When It Comes To Health Care Spending and Addressing The Social Determinants Of Health With Income Assistance).
There are some specific social determinant factors that are likely to have a greater impact in the post-crisis recovery period. Based on previous research, at the top of that list is housing insecurity and food insecurity. With a 20-point increase in unemployment in the past eight weeks, a wave of mortgage foreclosures and rental evictions are likely to follow. A third of the 13.4 million renters in the U.S. (31%) could not pay their rent at the beginning of April, a number that is likely to have risen in May (see New Data Shows More Americans Are Having Trouble Paying Their Rent and Facing Eviction As Millions Shelter In Place). Past research has also found that consumers who lack housing stability have higher rates of emergency department use and hospitalizations (see Housing Instability And Food Insecurity As Barriers To Health Care Among Low-Income Americans).
The rising unemployment rate is also creating food insecurity. The first day that 10,000 families showed up for food at a San Antonio food bank really caught my attention (see The San Antonio Food Bank Was Swamped By 10,000 Families In One Day, And The Images Are Surreal). Since then, we’ve learned that this is not an isolated situation and access to food is a big issue (see The Number Of Mothers Reporting Food Insecurity Has Jumped More Than 200% Since Start Of Pandemic and Coronavirus Is Exacerbating America’s Hunger Crisis). In the U.S. alone, one in five households—and two in five households with children 12 and under—are now food insecure (see The COVID-19 Crisis Has Already Left Too Many Children Hungry In America). Add to this picture that 29.7 million children who used to receive low-cost or free food through the National School Lunch Program have lost access to that resource (see How US Schools Are (And Aren’t) Providing Meals To Children In The Covid-19 Crisis).
On average, health care costs for food insecure adults are $1,834 higher than people who are food secure (see State-Level And County-Level Estimates Of Health Care Costs Associated With Food Insecurity). Also on average, food insecurity added about 11% to the health care costs of older adults (see Incremental Health Care Costs Associated With Food Insecurity And Chronic Conditions Among Older Adults). This is happening at a time when access to SNAP and food assistance benefits has been tightened. And aggravating the situation was today’s report that in April, grocery prices have jumped 2.6%—the largest one-month increase since February 1974 (see US Grocery Costs Jump The Most In 46 years, Led By Rising Prices For Meat And Eggs).
The increased need for social supports is going to run head long into the likelihood that budget-strapped payers are going to look to more managed care and value-based reimbursement to improve value for health care spending. The challenge is that almost a third of the organizations managing risk-based contracts report that addressing social determinants is the greatest challenge to managing the arrangements (see 23% Of Provider Organizations Have Launched ‘Successful’ Value-Based Care Pilots and Social Factors Are Primary Impediments To Managing Care For High-Cost Medicaid Beneficiaries). Even the debrief on the performance of the hot spotting initiative in Camden reported that “success” was hindered by social factors (see Is Care Coordination A Bust Without Social Services?).
Like many crises, there are opportunities for some provider organizations in this intersection of social services and health care. Health and human service organizations operating under risk-based or value-based agreements (health plans, accountable care organizations, health systems, etc.) are going to be more focused on policies that expand the social safety net, on connecting consumers to those social safety net services, and determining a return-on-investment for paying for selected social services. This is an opportunity for organizations with this expertise and the ability to quantify the impact of specific social service supports.
For more on the future of social determinants, and innovations in social support programs, check out these resources in The OPEN MINDS Industry Library:
- Payers Approaches To Addressing Social Determinants Vary
- Is Care Coordination A Bust Without Social Services?
- One Health Plan’s Partnership Approach To Social Determinants
- Integrating Social Care Into The Delivery Of Health Care: Moving Upstream To Improve The Nation’s Health
- Massachusetts To Launch Initiative Addressing Social Determinants Of Health In 2020
- Humana Medicare Advantage Plans To Pay Providers To Address Social Determinants Of Health
- Medicare Data Indicates 4.7% Rise In Use Of Z Codes To Document Social Determinants Of Health
- Social Determinant ROI—The Early Returns
- Five Keys To ‘Partnering’ With Health Plans On Social Determinants
- Paying For Social Services ‘Value’ Requires Measuring Cost Impact
For even more on developing and adopting innovative treatments in the face of uncertainty, join my colleague and OPEN MINDS Senior Associate, Paul M. Duck, on August 25 in Newport Beach, California for The OPEN MINDS Care Innovation Summit: Solving The Problem Of Access For Consumers With Complex Care Needs.