Payers Innovative Approaches to Social Determinants of Health and their Impact on Reducing Healthcare Disparities and Improving Health Outcomes

As we work to put our patients first in our organizations, we need to be sure that we are considering all aspects of what can be impacting their care. One such aspect to consider is Social Determinants of Health (SDoH). Being the environment that our patients exist in, SDOH plays a very big role in the level of care our patients receive. For example, if you have implemented digital tools designed to increase patient access but fail to consider whether these tools are available in the language your patient speaks or if your patient has the means to access these digital tools, you have created a new barrier for your patients instead of increasing access. The areas that we need to consider SDoH are endlessly vast, which can be very overwhelming so today we are going to narrow that down to payer innovative approaches and their impact on healthcare.

We reached out to our brilliant Healthcare IT Today Community to ask them – how are payers addressing the SDoH through innovative approaches and what impact do these initiatives have on reducing healthcare disparities and improving health outcomes? The following are their answers.

Andy Nieto, Senior Global Solutions Manager at Lenovo
In the overall healthcare environment, there has been a push for greater inclusion of fee-for-value-based payment models that focus on outcomes instead of fee-for-service models. Prioritizing improved population health outcomes through a value-based payment structure can offer providers a motivation to engage with underserved populations to address chronic conditions, like hypertension or diabetes, who might not receive care otherwise.

David J. Sand, MD, MBA, Chief Medical Officer at ZeOmega
The healthcare industry has been aware of social risk factors for decades. Similarly, for almost as long, health plans have known what they could do, but questioned what they should do. One of the most exciting benefits of new analytics technology in healthcare is the ability for health plans to understand populations at risk, identify their specific risks, understand which are the critical risks affecting the well-being of different cohorts, determine what interventions are available to mitigate those risks, execute the interventions, and measure the outcomes and ROI.

By taking strategic insights and placing them side by side with the enterprise’s capabilities and resources, payers can make intelligent and impactful choices to address and mitigate social risks. With the myriad of solutions available, technology can also be used to assess an individual, make an appropriate referral to a provider organization, track the referral and verify delivery and completion of the service, and report on the outcome in a closed-loop manner.  

Dana McCalley, VP of Value-Based Care at Navina
There’s a large—and largely untapped—opportunity to better support patients when we understand their needs holistically. Social determinants of health, or SDoH, are an important part of that effort. A major challenge facing payers in relation to SdoH is the lack of direct member contact.

Providers can help payers gain visibility into SDoH needs within member populations, and payers are trying to find ways to encourage providers to report structured and discrete SDoH data, usually reported via ‘Z codes’. A challenge with collecting ‘Z codes’ is that once you’ve identified a disparity, you need resources to act on it, and those aren’t always readily available. Yet this increased awareness can still help payers identify opportunities for preventive care measures and consider developing more targeted and specific offerings tailored to the unique needs of certain markets or communities.

Jenn Kerfoot, Chief Strategy & Growth Officer at DUOS
Right now health plans are investing heavily in health equity initiatives to address SDOH needs. The first reason is to meet the goals and requirements set by CMS, and the second reason, is there has been an industry recognition that to deliver on the promise of value based care which is predicated on going upstream before an individual has their health outcomes compromised due to SDOH impacts. Do not wait until members are cutting pills and missing medications to take action.

Health plans are taking innovative approaches and partnering with digital health companies to deploy contextualized and personalized member engagement that goes beyond what has historically been a transactional relationship with members. In deploying solutions that work through the member’s needs to achieve optimal financial performance the results are increased retention for payors but also, better management of chronic conditions through preventative care.

Michael Gould, VP of Interoperability Strategy at ZeOmega
Payers have adopted innovative approaches that apply AI, ML, and data analytics to identify individuals whose health may be impacted by social determinants and determine the best interventions. These insights enable plans to reach at-risk members with expanded medical benefits, such as support for nutritious food, transportation, shelter, and maternal/post-partum/infant care. For example, a plan may provide transportation benefits to ensure members who face barriers get to appointments rather than canceling or not showing up. Ultimately, this promotes preventative steps and timely therapy and leads to better overall health outcomes.

The initiatives undertaken by payers to address social determinants of health have an impact on reducing healthcare disparities and improving population health outcomes. Given that social and economic disparities affect a significant portion of the population, these initiatives remove some hindrances to care that lie beyond the scope of medical practice and individual resources.

Leah Dewey, MPH, Vice President, Clinical and Consumer Engagement Operations at Cotiviti
Many health plans face difficulties in capturing social determinants of health (SDoH) data from their members. This is particularly true for Medicaid plans, which often have a large transient population that lack access to stable housing. Without this data, plans lack the ability to connect their members with appropriate resources, such as food, transportation, and housing support—and members become significantly more at risk of losing their coverage during the redetermination process as we’ve seen over the past year.

One approach some plans are taking is to use a combination of communication methods, such as texting, interactive voice response, and secure online portals, to survey their members about their SDoH challenges. For example, in a recent campaign, one large regional health plan successfully reached more than 90% of its targeted members and garnered valuable findings. These included 35% of respondents reporting that they were worried about food security, while 13% cited lack of reliable transportation.

This type of information is invaluable to health plans by empowering care managers to extend personalized support and assistance. In addition, the plan’s members logged more than 12,000 visits across websites to link them with essential services, including support for substance abuse.

Gabe Diop, Co-Founder of Rula Health
Evaluating the outcomes of behavioral health services can be much more challenging than, for example, tracking a patient’s response to insulin by monitoring blood sugar levels. However, there are still ways that payers can look at overarching trends informed by benchmark and progress measurements to understand whether a patient is receiving appropriate and effective care. Behavioral health providers – as well as payers – are turning to the unique data analysis capabilities of digital mental health companies to gather insights into a patient’s symptoms and evaluate it alongside patient histories and demographics as a way of informing ongoing care plans and treatment.

Understanding that many aspects of life, including age, race, and sexual orientation, can affect a patient’s mental health outcomes or even the likelihood of receiving care is one crucial component to providing personalized and effective care that helps patients get better faster. By recognizing these issues and helping facilitate care among at-risk groups, payers can use data to ensure patients are receiving mental health support that is tailored to their individual needs and journeys.

Yousuf Ahmad, President and CEO at AssureCare
Payers recognize the impact of social determinants of health on populations and are innovating to address these disparities. Zip codes often dictate health more than genetic codes and payers are implementing have initiatives to target associated social, economic, and environmental barriers. In other examples, payers use AI to direct clinical resources efficiently and target specific interventions. For example, new payer programs integrate nutritional interventions into healthcare regimens, such as gluten-free diets for conditions like Multiple Sclerosis (MS). These efforts showcase a holistic approach to improving population health outcomes.

So many good insights here! Huge thank you to Andy Nieto, Senior Global Solutions Manager at Lenovo, David J. Sand, MD, MBA, Chief Medical Officer at ZeOmega, Jenn Kerfoot, Chief Strategy & Growth Officer at DUOS, Michael Gould, VP of Interoperability Strategy at ZeOmega, Leah Dewey, MPH, Vice President, Clinical and Consumer Engagement Operations at Cotiviti, Gabe Diop, Co-Founder of Rula Health, and Yousuf Ahmad, President and CEO at AssureCare for taking the time out of your day to submit a quote! And thank you to all of you for taking the time to read this article! We could not do this without your support. How do you think payers are addressing the social determinant of health through innovative approaches? What impact do you think these initiatives have on reducing healthcare disparities and improving health outcomes? Let us know either in the comments down below or over on social media! We’d love to hear from all of you!

As we work to put our patients first in our organizations, we need to be sure that we are considering all aspects of what can be impacting their care. One such aspect to consider is Social Determinants of Health (SDoH). Being the environment that our patients exist in, SDOH plays a very big role in the level of care our patients receive. For example, if you have implemented digital tools designed to increase patient access but fail to consider whether these tools are available in the language your patient speaks or if your patient has the means to access these digital tools, you have created a new barrier for your patients instead of increasing access. The areas that we need to consider SDoH are endlessly vast, which can be very overwhelming so today we are going to narrow that down to payer innovative approaches and their impact on healthcare.

We reached out to our brilliant Healthcare IT Today Community to ask them – how are payers addressing the SDoH through innovative approaches and what impact do these initiatives have on reducing healthcare disparities and improving health outcomes? The following are their answers.

Andy Nieto, Senior Global Solutions Manager at Lenovo
In the overall healthcare environment, there has been a push for greater inclusion of fee-for-value-based payment models that focus on outcomes instead of fee-for-service models. Prioritizing improved population health outcomes through a value-based payment structure can offer providers a motivation to engage with underserved populations to address chronic conditions, like hypertension or diabetes, who might not receive care otherwise.

David J. Sand, MD, MBA, Chief Medical Officer at ZeOmega
The healthcare industry has been aware of social risk factors for decades. Similarly, for almost as long, health plans have known what they could do, but questioned what they should do. One of the most exciting benefits of new analytics technology in healthcare is the ability for health plans to understand populations at risk, identify their specific risks, understand which are the critical risks affecting the well-being of different cohorts, determine what interventions are available to mitigate those risks, execute the interventions, and measure the outcomes and ROI.

By taking strategic insights and placing them side by side with the enterprise’s capabilities and resources, payers can make intelligent and impactful choices to address and mitigate social risks. With the myriad of solutions available, technology can also be used to assess an individual, make an appropriate referral to a provider organization, track the referral and verify delivery and completion of the service, and report on the outcome in a closed-loop manner.  

Dana McCalley, VP of Value-Based Care at Navina
There’s a large—and largely untapped—opportunity to better support patients when we understand their needs holistically. Social determinants of health, or SDoH, are an important part of that effort. A major challenge facing payers in relation to SdoH is the lack of direct member contact.

Providers can help payers gain visibility into SDoH needs within member populations, and payers are trying to find ways to encourage providers to report structured and discrete SDoH data, usually reported via ‘Z codes’. A challenge with collecting ‘Z codes’ is that once you’ve identified a disparity, you need resources to act on it, and those aren’t always readily available. Yet this increased awareness can still help payers identify opportunities for preventive care measures and consider developing more targeted and specific offerings tailored to the unique needs of certain markets or communities.

Jenn Kerfoot, Chief Strategy & Growth Officer at DUOS
Right now health plans are investing heavily in health equity initiatives to address SDOH needs. The first reason is to meet the goals and requirements set by CMS, and the second reason, is there has been an industry recognition that to deliver on the promise of value based care which is predicated on going upstream before an individual has their health outcomes compromised due to SDOH impacts. Do not wait until members are cutting pills and missing medications to take action.

Health plans are taking innovative approaches and partnering with digital health companies to deploy contextualized and personalized member engagement that goes beyond what has historically been a transactional relationship with members. In deploying solutions that work through the member’s needs to achieve optimal financial performance the results are increased retention for payors but also, better management of chronic conditions through preventative care.

Michael Gould, VP of Interoperability Strategy at ZeOmega
Payers have adopted innovative approaches that apply AI, ML, and data analytics to identify individuals whose health may be impacted by social determinants and determine the best interventions. These insights enable plans to reach at-risk members with expanded medical benefits, such as support for nutritious food, transportation, shelter, and maternal/post-partum/infant care. For example, a plan may provide transportation benefits to ensure members who face barriers get to appointments rather than canceling or not showing up. Ultimately, this promotes preventative steps and timely therapy and leads to better overall health outcomes.

The initiatives undertaken by payers to address social determinants of health have an impact on reducing healthcare disparities and improving population health outcomes. Given that social and economic disparities affect a significant portion of the population, these initiatives remove some hindrances to care that lie beyond the scope of medical practice and individual resources.

Leah Dewey, MPH, Vice President, Clinical and Consumer Engagement Operations at Cotiviti
Many health plans face difficulties in capturing social determinants of health (SDoH) data from their members. This is particularly true for Medicaid plans, which often have a large transient population that lack access to stable housing. Without this data, plans lack the ability to connect their members with appropriate resources, such as food, transportation, and housing support—and members become significantly more at risk of losing their coverage during the redetermination process as we’ve seen over the past year.

One approach some plans are taking is to use a combination of communication methods, such as texting, interactive voice response, and secure online portals, to survey their members about their SDoH challenges. For example, in a recent campaign, one large regional health plan successfully reached more than 90% of its targeted members and garnered valuable findings. These included 35% of respondents reporting that they were worried about food security, while 13% cited lack of reliable transportation.

This type of information is invaluable to health plans by empowering care managers to extend personalized support and assistance. In addition, the plan’s members logged more than 12,000 visits across websites to link them with essential services, including support for substance abuse.

Gabe Diop, Co-Founder of Rula Health
Evaluating the outcomes of behavioral health services can be much more challenging than, for example, tracking a patient’s response to insulin by monitoring blood sugar levels. However, there are still ways that payers can look at overarching trends informed by benchmark and progress measurements to understand whether a patient is receiving appropriate and effective care. Behavioral health providers – as well as payers – are turning to the unique data analysis capabilities of digital mental health companies to gather insights into a patient’s symptoms and evaluate it alongside patient histories and demographics as a way of informing ongoing care plans and treatment.

Understanding that many aspects of life, including age, race, and sexual orientation, can affect a patient’s mental health outcomes or even the likelihood of receiving care is one crucial component to providing personalized and effective care that helps patients get better faster. By recognizing these issues and helping facilitate care among at-risk groups, payers can use data to ensure patients are receiving mental health support that is tailored to their individual needs and journeys.

Yousuf Ahmad, President and CEO at AssureCare
Payers recognize the impact of social determinants of health on populations and are innovating to address these disparities. Zip codes often dictate health more than genetic codes and payers are implementing have initiatives to target associated social, economic, and environmental barriers. In other examples, payers use AI to direct clinical resources efficiently and target specific interventions. For example, new payer programs integrate nutritional interventions into healthcare regimens, such as gluten-free diets for conditions like Multiple Sclerosis (MS). These efforts showcase a holistic approach to improving population health outcomes.

So many good insights here! Huge thank you to Andy Nieto, Senior Global Solutions Manager at Lenovo, David J. Sand, MD, MBA, Chief Medical Officer at ZeOmega, Jenn Kerfoot, Chief Strategy & Growth Officer at DUOS, Michael Gould, VP of Interoperability Strategy at ZeOmega, Leah Dewey, MPH, Vice President, Clinical and Consumer Engagement Operations at Cotiviti, Gabe Diop, Co-Founder of Rula Health, and Yousuf Ahmad, President and CEO at AssureCare for taking the time out of your day to submit a quote! And thank you to all of you for taking the time to read this article! We could not do this without your support. How do you think payers are addressing the social determinant of health through innovative approaches? What impact do you think these initiatives have on reducing healthcare disparities and improving health outcomes? Let us know either in the comments down below or over on social media! We’d love to hear from all of you!