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By Sarah C. Threnhauser

Over the past few years, payer and health plan interest in social support services—housing, transportation, nutrition, and more—has reached a new peak. A quick scan of the headlines illustrates the wave of health plan investments in social support services:

  1. Blue Cross Launches Food Delivery Program To Address Social Determinants
  2. Kaiser Permanente Invests In Affordable Housing Complex In Oakland, California For $5.2 Million As Part Of Initiative To Improve Community Health By Addressing Housing Insecurity
  3. Lyft Expands Work With Blue Cross Blue Shield, Humana Medicare Advantage Plan
  4. Humana Foundation Dedicating $7 Million To Address Social Determinants Of Health
  5. Health Partners Plans Shows Positive Outcomes From “Food As Medicine’ Nutrition Program

In addition to these health plan-specific program examples, there are also more systematic approaches afoot. A recent reports show that 80% of health plans now use one or more methods to identify and address social determinants of health—with 42% of payers integrating referrals to community-based social service programs and resources; 33.7% integrating consumer medical information with consumer financial, census, and geographic data; 31.1% offering a “social needs” assessment along with health risk assessments; and 70% of payers are integrating awareness of social determinants of health directly into clinical processes (see 80% Of Payers Use One Or More Methods To Address Social Determinants Of Health). A good example of more systematic health plan initiatives include the recent announcement from UnitedHealthcare to expand its efforts to identify consumers who have non-medical needs considered social determinants of health (see UnitedHealthcare Expands Initiative To Use Diagnostic Codes To Capture Social Determinants Of Health).

But coverage of a recent conference on the issues surrounding social determinants put this interest in perspective for me—and solidified the challenge for provider organizations that are looking for long-term sustainable service opportunities addressing social determinants (see Kaiser, Dignity Health Executives: Better Strategy Needed To Get ROI From Social Determinants Initiatives). The health plan presenters described their current initiatives as “a smattering right now” and “random acts of kindness.” They said that the current social determinant initiatives are “too fragmented” to have an impact and “a strategic challenge most health systems encounter is trying to build a business case showing a return-on-investment (ROI) based on reduced cost or improved health outcomes.”

This is a call to action for any provider organization management team that hopes that their social services-infused approaches to health care will become a long-term market. Without proof of ROI, these initiatives will become one-time public relations investments, rather than long-term programmatic approaches adopted by payers and health plans.

So, like any new service approach, management teams with a “great new idea” need to embrace the need for a proof of concept, a measure of ROI, and a plan to take the service to scale. There are a few basic steps, outlined in my previous article, Selling Social Services To Payers & Health Plans: A Step-By-Step Approach:

  1. Assess your organization’s ability to deliver social support programs—services, geographic reach, consumers, and more
  2. Review health plan/ACO enrollment in your the geographic service area to identify target consumers
  3. Develop a concept statement about your social support services that are appropriate to the health plan consumers—services, costs, and performance metrics
  4. Meet with health plan/ACO managers to start the dialogue and present your service line concept
  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 getting to the demonstration pilot stage is just the first step on this journey. The pilot project needs to be designed to measure performance and conduct an ROI analysis for your 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 I think will need to be led by entrepreneurial provider organization executives.

If your organization has conducted payer-focused ROI analysis of a program or service line, I hope you’ll contact our team at OPEN MINDS. We’re planning to showcase these analyses at our executive institutes in the year ahead. In the meantime, to get more background on our work in ROI, check out these resources from the OPEN MINDS Industry Library:

  1. Technology ROI: Value-Based Purchasing For Executives
  2. On-Line Cognitive Behavioral Therapy: The Return-On-Investment For Health Plans: A Web Briefing
  3. On-Line Cognitive Behavioral Therapy: The Return-On-Investment For Health Plans
  4. For Telehealth, The ROI Is Where You Plan For It
  5. More Tools For Tech ROI
  6. In All That Tech Spending, Don’t Forget The ROI
  7. The New ROI Numbers On Brain Training
  8. Are You Getting The EHR ROI That You Should?
  9. The ROI Of Recidivism Prevention
  10. Solve For The Payer: How To Use Outcomes Tools To Calculate Data-Driven ROI That Payers Can’t Ignore

For more, join me on June 4 at The 2019 OPEN MINDS Strategy & Innovation Institute for the session “Self-Determination In The I/DD Market: Keys To Incorporating Consumer-Directed Care Into Your Services,” featuring Ray Wolfe, J.D., Senior Associate, OPEN MINDS; Dan Ohler, Vice President, State Government Programs, Optum Behavioral Health; and Mollie Murphy, President, Applied Self-Direction.

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