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Payers Integrate Virtual, In-Person Social Determinants Support

As businesses and health centers slowly reopen, these payers are finding ways to provide social determinants support both through virtual technology and in-person services.

Kelsey Waddill
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Published: 13 Oct 2020

When Blue Shield Promise and LA Care shut down their in-person community resource centers in March 2020, they leveraged virtual platforms to connect members with social determinants of health resources. Now that the centers can open, the payers are navigating the challenges of reopening as well as exploring ways to integrate virtual and in-person community support.

The connection between Blue Shield Promise and LA Care started several years ago when Blue Shield Promise began managing coverage for LA Care’s MediCal members. However, in 2019 it evolved into a more substantial partnership.

In December of that year, the two health plans opened their first joint resource center and were in the process of opening more locations together. Like LA Care’s other community resource centers, this site connected members with local resources to address social determinants of health needs. Both health plans had staff on location to support members.

“One of the core functions that we wanted for this partnership was really meeting our members where they were,” Kellie Todd Griffin, senior director of community and stakeholder engagement for Blue Shield Promise, told HealthPayerIntelligence. “What we recognized in the experience of the resource centers that LA Care had already opened as well as our resource center, is that there needed to be a little more robust programming and integration into the community.”

Like many other health centers, Blue Shield Promise and LA Care pivoted to offering social determinants of health resources and wellness programming online during the shutdown. This included conducting healthy cooking demonstrations and exercise classes online.

The sites opened their doors again on October 1, after several months without visitors. But even as the centers reopened to in-person visitors, the payers recognized that many in their communities would still need virtual access to resources, as the pandemic continues.

“When you really think about reopening, we recognize that not everyone is going to be able to go back to some sort of space where they're coming and going,” explained Griffin. “There is no one solution for everyone.”

It was clear that an integration of virtual resources and in-person services would be the best way to continue addressing  social determinants of health in the post-shutdown period. Increasing telehealth access by offering free technology and WiFi provided the perfect opportunity to mingle both in-person and virtual support.

Enabling telehealth technology access

The plans knew that, although MediCal members were eligible for free telehealth benefits, not every member had access to telehealth technologies.

Studies have exposed socioeconomic and racial disparities in telehealth access and utilization, which were especially illuminated during the coronavirus pandemic.

During the pandemic, 32 percent of telehealth users at Mount Sinai hospital in New York City were White individuals, while 19 percent were of Black or Hispanic descent. Respondents were almost unanimously English-speaking. Even before the pandemic hit, however, socioeconomic status was a decisive factor in telehealth access.

“Because of COVID-19 a lot of the social services are also starting to do web-based,” said Griffin. “When it was time to enroll in Medi-Cal, the only option that they had was either calling or going online, and they needed assistance.” .

To break down telehealth barriers, the payers accelerated plans to offer a telehealth hub in their resource centers.

“This will give them an opportunity to be within the centers, to have someone to help them actually navigate, not just for medical services, but also overall services, like more health and wellness programming,” Griffin explained.

Blue Shield Promise and LA Care outfitted their resource centers with additional office spaces. Each space was private and had its own computer, equipped with a webcam.

“During the pandemic, we've seen the need for telehealth access really go up tremendously, so we're glad that we have those spaces available in the centers that we're going to be opening during the rest of the year,” Francisco Oaxaca, chief communications and community relations officer at LA Care, explained to HealthPayerIntelligence.

Thus, members without access to the technologies necessary for telehealth visits or who did not have a private space to conduct telehealth conversations could come to the resource centers. There, the health plans mingled virtual and in-person solutions to engage in a telehealth consultation.

Expanding WiFi access

Access to telehealth technologies was not the sole digital barrier that came to light during the pandemic.

Particularly with their MediCal population, Blue Shield Promise and LA Care were very aware that access to WiFi could be a social determinant of health for their members.

Recent federal activity has highlighted this problem. In April, the Federal Communications Commission offered six grants worth a total of $9.5 million to help expand WiFi access and telehealth access. At least half of these crucial grants targeted low-income individuals, underscoring the need for greater telehealth support for low-income communities.

“Many of the individuals who are in the population we serve—lower income individuals—either have limited or no data plan with their mobile device,” Oaxaca said. “There's really a great penetration of mobile devices, but now the limitation was the availability of a data plan.”

The payers offered free WiFi through their resource centers. Not only could members use WiFi Service at the resource centers, but the general public could as well. This aimed  to increase the likelihood that they would engage with a provider via telehealth.

In order to maintain a safe environment, individuals who wish to use the resource centers for either the telehealth hubs or WiFi access will need to make an appointment at centers that have these capabilities.

The payers said that they have been receiving calls from community members inquiring about when classes and programming will restart. They take these as a sign that their approach to community integration is working.

“It just points out some of the hidden value of the centers, which is that they really act as social hubs in the community,” Oaxaca said. “They give folks a safe, fun place to gather and not only receive services and information and take classes, but just to gather and make new friends, keep existing relationships. There seems to be real desire to be able to recapture that.”

“The need is great in our communities and these centers really are the epicenter of the work that we can do together to make sure that our communities are thriving,” Griffin agreed.

Looking to the future, the plans intend to open a total of 14 jointly-operated health centers across California in the next five years.

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