CareFirst Partnership Aims to Identify, Address Social Risk Factors

CareFirst BlueCross BlueShield (CareFirst) has partnered with a healthcare analytics company to help identify members with social risk factors and advance health equity.

By leveraging Socially Determined’s SocialScape platform, CareFirst will be able to recognize members facing social determinants of health barriers, such as financial challenges, housing instability, food insecurity, lack of transportation, and health literacy struggles.

The payer can then use this information to develop initiatives tailored to these needs.

“We understand just how significant socioeconomic factors are in keeping people and communities healthy, and it’s clear that relying on just clinical and claims data is no longer enough for any healthcare organization,” Stacia Cohen, executive vice president of Health Services for CareFirst, said in the press release.

“As a healthcare company and community champion, having access to this type of information helps guide our investments and allows us to better understand the needs of the communities we serve.”

The collaboration will support CareFirst in helping employers understand other factors that drive poor health outcomes for employees beyond clinical circumstances, such as social risk factors and social determinants of health.

Additionally, the payer can use the platform to identify which populations would benefit from investments in community-based programs, partnerships, and interventions. The social risk tool will also help CareFirst establish care management teams to support members with both social and clinical care needs, according to the press release.

CareFirst has worked with this partner in the past to address the diabetes epidemic. The healthcare analytics company provided the payer with community insights that helped CareFirst determine where to direct resources for its $10.5 million investment in Maryland’s Diabetes Action Plan.

The company found that commercially insured members with diabetes who faced high risks of food insecurity and health literacy had an annual total cost of care that was $3,000 higher than members who did not have these risks. The payer was then able to develop interventions for this specific population to help address these needs.

Payers have increasingly taken steps to address members’ social determinants of health, technologically and strategically.

For example, Humana partnered with a technology platform and Alamo Area Community Network to provide Medicare Advantage members access to local social determinants of health support. The partnership leveraged several healthcare stakeholders, including providers, payers, government agencies, and nonprofit organizations, to give members timelier access to social support and resources.

CMS has aimed to improve social determinants of health initiatives as well. The agency’s 2023 Medicare Advantage and Part D Advance Notice included recommendations for special needs plans to incorporate social determinants of health screening questions into their health risk assessments.

Employers are also in a critical position to address social risk factors among workers. Through gathering data, assessing current benefits, and partnering with payers and providers, employers can successfully identify and address social determinants of health.