Advice from a Home Care CMO on Social Determinants of Health

Dr. Elise Singer, CareLinx's Chief Medical Officer, is a practicing family physician and geriatrician, who now brings a much-needed depth of clinical understanding to the home care business. With decades of experience on both sides of the system, she has a clear vision of the future of healthcare - and it starts with health plans and provider organizations tackling social determinants of health.

In this interview, Dr. Singer opens up about her personal passion for improving home care, the complexity of navigating healthcare reform, and the burgeoning role of social determinants of health.

Q: You have a distinctive background, coming directly from medical practice and into the home care industry – how does this experience shape your work with CareLinx?

Dr. Singer: I studied as a geriatrician. It's a population that naturally dovetails with what we're doing at CareLinx, because they have the greatest functional status needs. And personally, I really love that population. I had a very close relationship with one of my grandmothers, and that helps me understand that being able to do something meaningful for someone in your own life is incredibly powerful.

For years everyone from the healthcare side has been trying to figure out how to properly integrate health services into the home. CareLinx has created the ideal infrastructure through its marketplace of tech-enabled caregivers, supporting a true, vital need: helping with the functional activities of daily living [ADL] in the home while simultaneously providing visibility and a mechanism for real-time action in the home.

I thought, and still believe, that CareLinx has a really elegant solution. It answers a lot of the issues that health care organizations have historically faced in trying to bridge that gap. I've worked with CareLinx to ensure our product directly addresses this need. Extending health into the home through caregivers enables our clients - ACOs, large health systems, or payers - to save on total cost of care and improve health outcomes.

Q: There’s definitely a shift in the focus of health policy in the U.S., from facility care to home care. How does CareLinx’s business model adapt to that? How can health plans and systems adapt to that?

Dr. Singer: The cost of home care assistance - via a caregiver agency, private caregiver, or otherwise - can be too much for most families, even though they have the need. CareLinx is unique in that our business model is a marketplace. Accordingly, we avoid high brick-and-mortar infrastructure expenses, keeping the costs down for families and individuals paying on behalf of a loved one. That, along with extremely high-quality standards and a network of more than 300,000 caregivers across the nation, means we have the right resources and are really well prepared for this shift in health policy.

Health systems and payers need to understand the ROI equation well enough to build home care into their own structure, and the changing environment puts a lot of time pressure on them. It causes a lot of uncertainty. Although they want to do the right thing and learn alongside us, the rapid changes and tightening of the belt across the industry make it really challenging from every direction.

I think everyone in the industry faces this uncertainty, but we make the learning feasible by helping the right patients or members address activities of daily living and social determinants of health in a meaningful, effective and affordable way. We're proud to say that’s been part of our business model all along. It makes us, and our clients, extremely well-positioned to succeed in this environment.

“The bottom line is that social problems deeply and adversely affect health. It’s proven. And CareLinx has demonstrated that our model is effective, especially when we work together with providers and payers.”

Q: You’ve mentioned social determinants of health, which has become something of a hot topic in the industry. Why do you think that is?

Dr. Singer: In short, it's proven with data in a way that it wasn't before. There's really good evidence now from multiple different studies that show that non-direct issues affect health outcomes. For example, social isolation can be as dangerous as smoking. It's been well known for some time that a lot of basic healthcare needs, like primary care doctor appointments or groceries, aren't met because people can't access them for one reason or another.

As a physician in Camden, New Jersey, I routinely saw patients who would call ambulances and go to the emergency room because they didn't have a ride to come see me or a specialty care colleague. That’s just transportation.

Financial issues overlay all of this. If someone doesn't have money for housing, they're not going to have money for cheap, life-altering medications, like insulin. If someone has to sleep outside or couch surf, they're uniquely vulnerable to losing their medications, or having them stolen, if they've even been able to procure them.

These are somewhat dramatic examples, but variations of this same story play out in large percentages of the population, especially the senior population.

The bottom line is that social problems deeply and adversely affect health. It’s proven. And CareLinx has demonstrated that our model is effective, especially when we work together with providers and payers.

Q: How does the combination of CareLinx, senior home care, and social determinants of health translate into savings and improved outcomes for health plans?

Dr. Singer: Not to overstate it, but it is incredibly complicated. If you take 10 seniors, they might need 10 slightly different in-home care solutions. CareLinx knows this and addresses it by allowing plans to have trained and scalable caregivers in the homes of those seniors, tailoring care to their unique needs. We do safety evaluations in the home and remedy risk factors that seniors and their families might not even know about, like tripping hazards. Our human, boots-on-the-ground caregivers can react to what each person needs in real-time - but it's also more than that. Our caregivers are providing transportation, picking up medications, shopping for nutritious food, and serving as companions - all while giving seniors the functional support they need to indirectly address other social determinants.

Then, information is sent to a skilled or medical person who will be able to synthesize the data. They can access the health and well-being information in an organized dashboard and manage large numbers of seniors at a population-level. Alerts are sent through the dashboard so that they know when something needs immediate attention versus having to wait. The in-home caregiver really plays a key role in the future of effective, scalable, and affordable healthcare.

Q: The future of healthcare will involve younger generations caring for their parents and families. How does what’s happening now with home care trickle down to impact those generations?

Dr. Singer: Millennials and Generation Xers spend a significant portion of their time thinking about, doing administrative work on behalf of, or working themselves to care for their loved ones. We know first-hand that the peace of mind that comes from the security of in-home healthcare is very real.

We actually have employer-sponsored programs that offer CareLinx as a benefit for that reason. Employers know that productivity is an important issue, and they want to have people on staff with their minds at work and not needing to take extended leaves or leave work outright.

Think of it this way – the equivalent for the right demographic is having a great nanny. You can fully be at work, 100% productive, and not worried when you have the right care at home for your loved ones. When you don't have that support, it's not only disruptive but you also are constantly worrying and distracted. So, it is a real help to have the right care.

Q: So, some health organizations are really “getting it right” – are there other ways you see the industry getting it right or wrong when it comes to the social determinants of health?

Dr. Singer: Absolutely. What's "right" is the acknowledgement that it's complicated and that these issues play a real role in health outcomes. There's an acknowledgement that factors that impact a person's health aren't happening in a silo.

On the other hand, what's "wrong" is that many are bound by the structure of the payment incentives that we live in. The isolation of the organizations that are able to provide those services is really handicapping efforts to make a bigger impact with solutions that address social determinants, like home care.

Q: How can payers and providers get more “right” and less “wrong” in addressing social determinants of health?

It's critical to tap into the local network of services in any community because healthcare is local. But we also need to have scalable solutions in our nation that are cost-effective. Those two facts are at odds with each other. This is why, for the right member or the right patient, leveraging an actual human on the ground, in the home, to orchestrate that patient's care, with oversight, education and direction by skilled, trained coordinators -- is going to be part of any long-term health solution. Because there is no other effective, affordable, cost-effective, and truly scalable solution.

Specifically for payers, taking that leap and identifying the right members, and then getting that most cost-effective, capable person in the home to help, begins to answer these issues on behalf of their members.

Whereas for providers, it's going to look like them putting in a little "extra," to innovate along with the rest of the system. They need to participate fully with the system to help make the change and improve the health outcomes of their members.

“There are people who need our help. None of us can be on the sidelines anymore. We've got to dive in, and we’ve got to do it together.”

Q: What is the one thing you think healthcare leaders need to know to effect change in the health services industry?

We have to understand that, when it comes to healthcare as a whole, we're not going to all get it perfectly right immediately and that is okay. It is okay for health professionals to get it 50% right, and then 75% right, and then 99% right in three years, or whatever the time table will be. It's the constant improvement that matters, and we need to learn together. If we don't, we're going to leave our most vulnerable people with insufficient care and poor health while bankrupting the government, our citizens and healthcare organizations, and that's unacceptable. There are people who suffer from food insecurity, mental illness, chronic disease, poverty, and other socioeconomic factors and they need our help. None of us can be on the sidelines anymore. We've got to dive in, solve for social determinants of health and other long-term health factors and we’ve got to do it together.

https://homehealthcarenews.com/2019/02/carelinx-buys-optimal-aging-platform-from-providence-st-joseph-health/