Data show that 80% of health care spending is driven by personal, social, and environmental factors, not health services. Robert M. Atkins, M.D., MPH, senior medical director of Aetna Medicaid, addressed this issue during the 2019 OPEN MINDS Executive Leadership Retreat (see Building A Trauma-Informed Informed Network—One Health Plan’s Approach) and explained Aetna’s strategy for exploring trauma-informed provider organization networks.
And Aetna is in good company. We’ve reported on Kaiser Permanente’s Thrive Local initiative that addresses social needs (see The 68%) and Anthem’s Care Heroes for consumers who need long-term support services (see LTSS Drives Whole-Person Care Strategies). These are great examples of health plan initiatives to address the social determinants of health.
But where are health plans overall? Our recent survey of health plans notes significant movement to address social determinants of health (SDoH) in a number of areas, including transportation, housing, and food insecurity (see Trends in Behavioral Health: A Population Health Manager’s Reference Guide on the U.S. Behavioral Health Financing and Delivery System). Not surprisingly, those initiatives are concentrated in Medicaid health plans.
Transportation initiatives: The new report shows that 21% of health plans surveyed are investing in transportation initiatives, with Medicaid leading the pack. It includes information about states using 1115 Demonstration waivers to address SDoH including transportation barriers to care. For example, Texas allows Medicaid health plans to cover transportation and activities that promote healthy lifestyles. We also reported on the fact that Lyft is working with Allscripts to integrate ride sharing into electronic health records, and the company has an agreement with Blue Cross Blue Shield (BCBS) Association that enables consumers with BCBS coverage to use the ride-sharing service without a charge (see Medicaid In Arizona Now Covers Lyft For Non-Emergency Transport, Grand Rounds & Uber Health Partner To Get Members To The Right Place, and Virginia Approves $7 Million Contract With G4S For Alternative Transportation For Crisis Mental Health).
Food insecurity: Our 2019 survey research found that 13% of all health plans are investing in this area, with Medicaid leading the way with 55% of plans investing in food insecurity initiatives. We recently covered the new Kaiser Permanente Thrive Local initiative, which connects consumers with community resources to address social determinants of health including referrals for affordable grocery programs (see Kaiser Permanente & Unite Us Team Launch Referral Network For Social Services). For more coverage of the food insecurity realm, check out Blue Cross Launches Food Delivery Program To Address Social Determinants and Health Partners Plans Shows Positive Outcomes From “Food As Medicine’ Nutrition Program.
Housing initiatives: Twenty-seven percent of all health plans surveyed are investing in this area with some high-dollar initiatives announced, including United Healthcare’s $350 million investment in housing projects and Kaiser Permanente’s $200 million investment in housing stability. Health plans are also investing in short-term housing and partnering with housing agencies to improve access to affordable housing (see Illinois Medicaid Announces 40 New Dementia Care Housing Sites, Boston Hospitals Launch $3 Million ‘Innovative Stable Housing Initiative’ and Montana Medicaid Planning A Supportive Housing Benefit).
What are the opportunities for specialty provider organizations in this environment? Developing programs that leverage knowledge of the social support needs of consumers. There are a few basic steps, which I outlined in Selling Social Services To Payers & Health Plans: A Step-By-Step Approach and include:
- Assess your organization’s ability to deliver social support programs—services, geographic reach, consumers, and more.
- Review health plan/accountable care organization (ACO) enrollment in your geographic service area to identify target consumers.
- Develop a concept statement about your social support services that are appropriate to health plan consumers—services, costs, and performance metrics.
- Meet with health plan/ACO managers to start a dialogue and present your service line concept.
- Refine your concept statement based on the conversation with health plan/ACO managers.
- Continue the dialog until you get to the demonstration pilot stage.
It’s important to note that getting to the demonstration pilot stage is the first step on this journey. Your pilot project needs to be designed to measure performance and return on investment (ROI) for the organization’s proposed approach. Without a solid ROI, your approach runs the risk of becoming another one-time, interesting experiment without long-term adoption. This is a tall order and one that needs to be led by entrepreneurial provider organization executives, which—according to the data—is starting to happen. The numbers are in.
For a deeper dive, check out these resources from The OPEN MINDS Industry Library:
- Social Determinants Of Health & Medical Homes
- Social Determinants Of Health – How Housing & Other Social Support Services Influence Spending
- Tending To The Social Determinants Of Health – Or Not
- Poverty Really Does Matter When It Comes To Health Care Spending
- Helping Consumers With Food Insecurity: What Services Are Available?
- A Question Of Permanent Supportive Housing
- The Social Service Factor In The Health Care Value Equation
- Social Isolation Linked To Higher Risk Of Death
- Why New Medicare Rules For ‘Non-Medical Benefits’ Matter
Join me at The 2020 OPEN MINDS Performance Management Institute in Clearwater, Florida on February 13 for the session, “Population Health Management For The Complex Consumer Market: How To Utilize Data To Coordinate Services Across The Care Continuum” featuring James Stewart, President & CEO, Grafton Integrated Health Network & Advisory Board Member, OPEN MINDS.