There has been increasing study of the impact of social determinants on health status and health care spending (see Going ‘Social’ – The Next Iteration Of ACOs and Strategies For Addressing The Social Determinants Of Health). With more data in hand, the call to expand population health management — via health plans and accountable care organizations (ACO) — to include structures to target social, environmental, and community factors has been growing. The discussion of TACOs (totally accountable care organizations, see TACOs, Anyone?) and social ACOs (see Going ‘Social’ – The Next Iteration Of ACOs and Building The ‘Next Generation’ Behavioral & Social Service ACO) are very interesting.
The social determinants of health are the conditions in which people are born, grow, live, work, and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels, according to the World Health Organization. These conditions are, in effect, “communities” — but even the definition of community is shifting. Gone are the days when the neighborhood or city you operated in was all that constituted your community. This is a serious constraint in trying to address social determinants in health systems. An understanding of the geographic, demographic, and institutional characteristics of their respective communities is key for how service providers and payers alike identify the proper service mix and evaluate the results.
How to address this issue? I recently turned to The Stanford Social Innovation Review article, “What Is Community Anyway?” In the article, authors David M. Chavis and Kien Lee described how “funders and evaluators [can] identify, understand, and strengthen the communities they work with.” The authors outlined five key ways to think about what constitutes a modern community:
- Communities are about relationships. Defining a community means recognizing the relationships between people — consumers and their neighbors and peers, consumers and their support groups, consumers and social service organizations, and consumers and institutions (like schools and churches). It also involves recognizing the relationships between primary care and behavioral health organizations; health care and social service organizations; and provider organizations and charities, social institutions, and government agencies.
- People live in multiple communities. If you’ve mapped out a complete community that’s great, but you’ll need the ability to do that again and again. Consumers are part of multiple communities that extend beyond their geographies. Where to start? Chavis and Lee note that communities are “often based on neighborhood, nation, faith, politics, race or ethnicity, age, gender, hobby, or sexual orientation.” Those qualities may overlap (or not), but finding all the ways consumers interact can help identify supports resources for your community-based efforts.
- Communities are nested within each other. The old mentality of seeing community as a physically constrained place (neighborhoods, cities, counties) can still apply here, but it often misses the subtleties of smaller, discrete communities within the larger ones.
- Communities have formal and informal institutions. You’re probably already familiar with institutions like schools, government, religious institutions, law enforcement, and social services, but that doesn’t cover all relevant social and cultural institutions. By way of example, Chavis and Lee identify “council of elders, barbershops, rotating credit and savings associations, gardening clubs” as being among the more informal organizations but there is practically no limit on the possible ways that people will organize themselves. And it’s often the “informal” organizations that are the most important for communities.
- Communities are organized in different ways. The “blueprint” you have for one community probably isn’t accurate enough to apply to a different community. For health and human service provider organizations operating in a time of growth — and under pressure from payers to scale successful service lines — this is a very acute challenge.
My takeaway? For health plans and ACO executives, and for “risk adjustment” in rates, better quantification of “community characteristics” and their relationship to costs is essential. And, as value-based reimbursement grows, managers of provider organizations also need the same understanding. This will mean dusting off your old market intelligence skills (see Market, Math & Metrics), reassessing consumer engagement with your brand (see Social Media Listening As Consumer Engagement Strategy), and refocusing your strategic efforts toward greater community impact (see Becoming A ‘Blue Chip’ Provider Organization).
For more on demand and budgets to address social determinants of health, check out these OPEN MINDS Market Intelligence reports: What Income Assistance Is Available To Consumers Through TANF & How Does It Vary By State?: An OPEN MINDS Market Intelligence Report, What Services Are Available For Nutrition Assistance & What Is U.S. Spending On Those Programs?: An OPEN MINDS Market Intelligence Report, and What Are The Supplemental Security Income (SSI) Program Eligibility Requirements & Benefits?: An OPEN MINDS Market Intelligence Report. And for more on forming the necessary relationships with ACOs operating in the community, don’t miss “There Is No Plan B: How To Demonstrate Your Value & Create The Collaborations That Matter In A Changing Market,” the closing keynote at The 2017 OPEN MINDS Strategy & Innovation Institute, taking place June 6-7, 2017, in New Orleans.