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By Monica E. Oss

The issue of “non-medical” factors on health care outcomes and health care spending continues to get attention. The reasons are obvious—social determinants of health (SDH) like nutrition, transportation, housing, and more have a big impact on health (see Social Risk & The ‘Value’ Of Health Care, Paying For Social Services ‘Value’ Requires Measuring Cost Impact, and Tending To The Social Determinants Of Health – Or Not).

So it is not surprising that 80% of health plan executives believe addressing SDH are important—42% are integrating SDH programs into their population health efforts, and 34% are using census and socioeconomic data to augment their clinical data (see The Possible Dark Side Of Social Determinants Of Health). For example, the Humana Foundation, the philanthropic arm of Humana Inc., announced it is dedicating $7 million to address social determinants of health-funding that aligns with the organization’s stated goal of improving the health of the communities it serves by 20% by 2020 (see Humana Foundation Dedicating $7 Million To Address Social Determinants Of Health). (For a rundown of what health plans, accountable care organizations, and other at-risk integrated delivery networks are doing to advance SDH, check out What Are Payers, Health Plans, & ACOs Doing About Social Determinants?).

But how do executives of provider organizations propose (and get paid for) solutions for health plans that address the SDH of their members. Our team has come up with a model for demonstrating the “ROI” of integrated health/social programs. For provider organization executive teams, this is where a specialized and focused approach to health plan/ACO marketing comes in (see Selling Social Services To Payers & Health Plans: A Step-By-Step Approach), based on six key steps:

  1. Assess your organization’s ability to deliver social support programs
  2. Review health plan/ACO enrollment in the geographic service area to identify target customers
  3. Develop a concept statement about your social support services
  4. Meet with health plan/ACO managers to start the dialogue
  5. Refine your concept statement based on the conversation with health plan/ACO managers
  6. Continue the dialog until you get to the demonstration pilot stage

But I gained a few tips for making integrated health/social programs from a newly-released report from the Blue Cross Blue Shield of Massachusetts Foundation, How Are Massachusetts Community-Based Organizations Responding To The Health Care Sector’s Entry Into Social Determinants Of Health?. Massachusetts has an accountable care organization (ACO) program combines shared savings and capitated payment arrangements with incentives to address the SDH using partnerships with community-based organizations—or community partners (CPs) as they are referred to (see Massachusetts’ Medicaid ACO Makes a Unique Commitment to Addressing Social Determinants of Health).

The steps that Massachusetts community-based provider organizations are taking are steps that would work with provider organizations anywhere as they look for an expanded relationship with health plans. The approach of those organizations includes:

CPs are hiring health care staff and adopting health care organization language—There has been a lot of talk about health care integration, and in preparation for SDH, CPs are putting the relevant professionals on staff and adopting “medical” language to help build the requisite culture before the shift occurs, and to streamline the communications between social service organizations and health care.

CPs are shifting metrics—Not all metrics are created equal, and they can’t simply be swapped for one another and expect to deliver the same information. CPs have recognized this and are changing to new metrics that are better at showing how SDH affect things like readmission rates and emergency department utilization. CPs are also starting to reconsider their value proposition in ways that show value to health care financing and utilization.

CPs are expressing enthusiasm for research and data—CPs are committed to building an evidence base, including participating in academic research and randomized control trials to show the effectiveness of their work. This was often in response to the priority that MassHealth ACOs place on demonstrating service efficacy.

CPs are presenting menus of service options—Instead of focusing on one service line, CPs are developing different service options that ACOs could purchase on behalf of their consumers, and as a step toward eventually providing a customized program of supports.

CPs are considering creating HUBs—In the Massachusetts context, a HUB is a lead agency or prime contractor, functioning as the contractors with health plans and subcontracting the service delivery to other provider organizations.

Expect to see more research, pilot programs, and controversy on the integration of social supports into health care delivery system. The issues are myriad—access, equity, privacy, and more. But the financial effects are large enough that adventuresome executives of both health plans and provider organizations will likely wade into these waters.

For more on our recent coverage of those issues, check out these resources from the OPEN MINDS Industry Library:

  1. Social Determinants Of Health & Medical Homes
  2. Social Determinants Of Health – How Housing & Other Social Support Services Influence Spending
  3. Tending To The Social Determinants Of Health – Or Not
  4. Poverty Really Does Matter When It Comes To Health Care Spending
  5. Helping Consumers With Food Insecurity: What Services Are Available?
  6. A Question Of Permanent Supportive Housing
  7. The Social Service Factor In The Health Care Value Equation
  8. Social Isolation Linked To Higher Risk Of Death
  9. Why New Medicare Rules For ‘Non-Medical Benefits’ Matter
  10. Medicare Advantage Plans Approved To Offer Expanded Non-Medical Supplemental Benefits

For more, join us at The 2019 OPEN MINDS Strategy & Innovation Institute, where OPEN MINDS Senior Associate John F. Talbot will present, Taking Action On Social Determinants: New Social Support Models For Consumers With Complex Conditions.

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