But there is a possible dark side to this interest in SDH. What if social determinants data could be used to set health insurance rates? There is some very thought-provoking recent coverage of this issue by ProPublica and NPR, Health Insurers Are Vacuuming Up Details About You – And It Could Raise Your Rates) that reports:
The health insurance industry has joined forces with data brokers to vacuum up personal details about hundreds of millions of Americans. The companies are tracking your race, education level, TV habits, marital status, net worth. Then they feed this information into complicated computer algorithms that spit out predictions about how much your health care could cost them.
I think this research is essential—to inform consumers about the risks of their behaviors to their well-being, to inform health plans about what “behavior modification” programs to invest in, and for public health planning. But, the willingness of consumers to participate in related research (and not fear the negative impact of “big data”) is threatened if we allow payers and health plans to use social determinants factors to set individual health insurance rates. This is why it is critical to preserve preexisting condition protections and the current policies of no annual/lifetime limit—and only allow a narrow range of factors to be used by health insuring organizations to set rates. Then, the health and human service field will be free to explore the scientific implications of social determinants data, and develop new solutions without worrying about the ethical and financial implications for individuals.
Now, you may be thinking, “I don’t want to pay more for my health insurance because of someone else, who smokes cigarettes and doesn’t exercise. Those people should pay more because they choose those behaviors.” I would counter that someone who is a vegan and lives in Cheyenne, Wyoming (which has the lowest air pollution in the United States) doesn’t want to pay more because you eat cheese and live in Visalia, California (which has the worst air pollution). In the long run, a large risk pool that uses science to identify cost-related risk factors, and develops public health solutions to them, is the most cost effective path.
The strategic issue for executives of health plans, care coordination programs, and health and human service organizations is how to get ahead of the curve. For more on SDH, check out these resources from the OPEN MINDS Industry Library:
- Nutrition For Better Health & Lower Costs
- Income Assistance Plays Role In Addressing Social Determinants Of Health – 2018 Update On SSI & TANF Trends Released By OPEN MINDS
- The Balloon Effect
- Leveraging Medicaid To Address The Housing Issue
- The Future Of Housing Support
- Paying For Social Services ‘Value’ Requires Measuring Cost Impact
- Social Risk & The ‘Value’ Of Health Care
- Medicare’s Path To Incorporating Social Determinants Into Value-Based Payment
- Are Health Plans The Future Of Social Service Funding?
- Social Determinants Of Health & Medical Homes
And be sure to join me on September 18 at The 2018 OPEN MINDS Executive Leadership Retreat, for the opening keynote address, “Key Issues Shaping The Market For Complex Consumers: The Health Plan Perspective On What Executives Need To Know To Succeed”, featuring William Lopez, M.D., CPE, Senior Medical Director-Behavioral Health at Cigna Behavioral Health.