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  • Writer's pictureCare Interface

How can health plans address social determinants and improve member health outcomes?

Social determinants of health (SDoH) have a significant impact on individual and population outcomes. Health plans are constantly striving to improve these outcomes and member experiences. By assessing social factors and addressing the challenges pertinent to those factors, payers can positively impact member-population health. A deeper understanding of factors that affect members' health can significantly reduce utilization and costs, thereby improving the overall plan performance.

Prevention is better than cure. Early identification and treatment of disease are more productive and less costly than emergency episodes of illness. However, the healthcare system is still not quite there yet; the processes still aren't efficient enough to encourage early intervention. But there is scope for reducing emergency episodes. To achieve this, it is essential to focus on each member's health history individually and learn about their environment.

Factors that are generally included as SDoH — housing, transportation, lifestyle, community, locality, and education — have major roles in determining an individual's health status. Incorporating pertinent data about these factors into patient management considerations is bound to improve the accuracy and speed of diagnosis, treatment plans, medication adherence, and health outcomes. However, accumulating the data and channeling it to the point of care is a challenge. Accessing and leveraging SDOH data in the care journey is the next milestone of healthcare.

Identifying and analyzing social determinants of health

Payers can utilize data from SDOH for health risk assessment, patterns of resource utilization, and other purposes. One of the key processes for improving member population health is identifying and stratifying high-risk members and then enabling the provider and care network to address them. Analyzing and developing a deep understanding of social factors can help health plans create more customized care plans, reducing hospitalizations and emergency visits.

Socially and economically, disenfranchised members will need to leverage community resources to stay healthy, and those resources need to be available to them.

Take, for instance, an elderly man who was sent back to his home after major surgery. He, however, did not have anybody to help him with cooking, cleaning, and basic chores, and was thus unable to recuperate at home. If he had access to community resources, such as home care services or meal delivery programs, he would have had less struggle with his daily needs and his recovery rate would likely have been much faster. He also would have been less susceptible to hospitalization due to lack of at-home care.

It is essential that payers ensure they are connected to their members, and that their members are connected to providers, caregivers, and community resources to stay healthy, satisfied, and engaged.

Automating the Real-time capture of member SDoH data

Enabling providers and caregivers with actionable SDoH insights

Accessing SDoH data alone is not enough to put that data to use. Predictive analytics must be applied to the data to assess the at-risk population, derive insights from it, and devise strategies to use the information to mitigate emergency visits for each member.

To drive improved health outcomes for a health plan, it is critical to identify members' health status and patterns in their medical health history. Leveraging members; utilization trends and clubbing them together with their social determinants can help providers and caregivers gauge the true picture of a member's health status. Diving deeper to identify ZIP code levels and census data can help identify members' surrounding environmental conditions, contributing valuable information for devising care plans for them.

How to leverage SDoH

Pairing the data together == the clinical data and social factors — can be challenging, as they come from different data sources and are not aligned in terms of standard, formats, and more. Innovaccer's Healthcare Data Platform for Payers can seamlessly integrate healthcare data from traditional sources with SDoH. Additionally, it analyzes which social determinant of health most directly impacts patients, drills down to every measure at the national, state, and county level, and strives to paint a clearer picture for care teams. It compiles county-level data for every social determinant of health and analyzes it to help providers understand the impact of various SDoH and track the performance of each county against national and state averages.

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