Why Health Plans Should Get Ahead of Their Social Determinants Strategy

There is a growing movement in the healthcare industry to address the “social determinants of health”, including such factors as food insecurity, housing, loneliness, connection to community and proximity to care services. Healthier environments beget healthier populations. This translates to lower healthcare costs throughout communities. More and more often, executives use the line that health is more about “zip codes than genetic codes.” What’s happening here, is that health systems are rethinking how they can serve their communities. Geisinger, a health system well known for innovation based in rural Pennsylvania, has begun “prescribing” healthy family meal programs and offering free transportation to patients within 50 miles of its facilities. Just last month, Northwell Health partnered with Inland Harvest Food Bank to launch a program to address food insecurity in New York State.

Why Social Determinants Matter

There’s good reason for the recent focus on social determinants. U.S. healthcare spending is expected to grow at an average rate of 5.5 percent per year through 2026 and evidence is growing that social determinant initiatives help improve population health. “What we know is that a person’s health is inextricably tied to educational outcomes, employment and wages, and access to affordable housing,” Dr. Katrina Hedberg, state health officer and epidemiologist at Oregon Health Authority’s Public Health Division, said this month when the organization released its 2018 state health assessment. Participation in a food program was associated with fewer emergency department visits for dual-eligible Medicare and Medicaid populations. Baylor Scott & White Health reduced rates of emergency room visits in Dallas for low socioeconomic status by addressing social determinants through the integration of primary care clinic efforts with wellness programs. These upstream efforts have huge implications downstream for the healthcare industry. Companies are looking to get ahead of their customer’s health problems by offering them the lower-cost tools they need — be it food or a ride to a primary care appointment — to prevent higher-cost chronic conditions that have worse health implications, such as obesity or diabetes.

What Can Insurers Do? Be Proactive

Forward-thinking health plans are leading the efforts to drive down U.S. healthcare spending by offering its members benefits related to social determinants. Humana, for example, in 2016 targeted food insecurity, loneliness, and social isolation to address their impacts on members’ number of healthy days. Results have been varied but the payer has found these efforts have proved a slight improvement in healthy days for senior members living in Kansas City with diabetes. Last month, UnitedHealthcare awarded $1.95 million in grant funding to Wisconsin organizations to address issues such as food insecurity. This builds on the company’s overall social work. The insurer partnered with Massachusetts Housing and Shelter Alliance to help individuals with mental health issues find housing. Payers have already been leading the transition to value-based care by driving members to lower-acuity care settings or reimbursing for virtual visits. Insurers who want to stay at the forefront of health and reform care must build strategic partnerships to manage preventive care — we can help with that.