How UPMC Coordinates Compounding Social Determinants of Health

Payers can no longer ignore the social determinants of health that impact its member’s lives. Countless studies have linked housing, food insecurity, transportation, and access to care to negative health outcomes.

Yet tackling each of these issues can be a challenge for payers as these risk factors are outside of its traditional responsibilities and benefits packages.  

For over a decade, the University of Pittsburgh Medical Center (UPMC) Health Plan has been implementing various initiatives across the organization to address member’s social determinants of health.

One of its most successful programs, the Cultivating Health for Success, partnered with a local housing and urban development vendor to coordinate a team-based approach that integrates permanent housing and intensive case management for individuals experiencing homelessness.

In the first five years of the program, UPMC showed a savings of over $6,384 for each of the 51 members it was able to house.   

“The premise was if we provided stable housing, people would be able to get a better handle on their own healthcare,” said John Lovelace, president of government programs at UPMC Health Plan.

Anecdotally, Lovelace reported members in this program would go to the hospital because they did not have anywhere else to go, which was driving high healthcare costs. But providing permanent supportive housing to the homeless can reduce healthcare costs by 59 percent.

The success of several pilot social determinants of health programs at UPMC sparked even more initiatives addressing food insecurity, community economic development, and transportation. Many of these programs were built into member’s benefits, but still, the payer struggled to coordinate these services.

“There’s lots of overlap,” Lovelace pointed out. “Housing overlaps with food insecurity, overlaps with medical problems, overlaps with legal issues like tenancy which then goes back to housing.”

A Medicaid member is eligible for SNAP benefits, for example. But not every Medicaid member who would benefit from the SNAP program receives these resources because the application process is confusing and disjointed. Each application has different requirements, rules, and deadlines.

“There are vacancies because nothing’s connected to anything else,” Lovelace furthered. “It’s very hard for people to navigate all this and figure out what to do next. The idea is to be able to get a better picture of the impact of what we’re doing in a social impact bonds sense.”

To better coordinate care across social needs, UPMC announced its Social Impact Initiative. The initiative will consolidate the organization’s social determinants of health efforts and develop strategic plans for programming to understand responsible and impactful investment opportunities. 

“While this work was happening in different areas, we hope to bring better coordination and ultimately better evidence to replicate more of the good things that are happening,” said Ray Prushnok, associate vice president for government programs at UPMC Health Plan.

The initiative will be housed under UPMC’s Center for High-Value Health Care.

“While it’s led through our government products business, it’s part of our Center for High-Value Health Care so that we can bring an evaluation lens to this work, prove what works, and disseminate that across other lines of business,” Prushnok explained.

One of the critical components of the initiative is the data exchange. Partnering with the county service managers, UPMC will have access to an entirely new set of data. This will allow the payer to paint a more complete picture of its members and understand how its work in the social determinants of health space is impacting child protective services, parole, SNAP, probation, employment, housing, and shelters.

“It gives both the county and us the ability to have a much more robust picture of how people are tracked in the system in various places,” Lovelace noted.

UPMC’s work aims to reduce unnecessary hospitalizations and improve the health outcomes of its members. But if these members are negatively impacted by other areas of the system, UPMC’s work is not complete.

A member avoiding hospitalization because he is in jail would show UPMC their goals are not achieved yet, Lovelace emphasized.

“It’s really an effort to pull all this stuff together into a single lens and look at impact more broadly,” he continued.

Data exchange will also help to identify gaps in care.

“We can have a better data exchange that informs us where the need is greatest, and we’ll start there,” Prushnok said.

The data exchange will help UPMC support members and ensure they are receiving all the benefits they qualify for.

“When you add up all these income supports you can make sure people are receiving the benefits that they qualify for,” Prushnok furthered. “We hope they then can pay closer attention to their health once we’ve removed the stressors that come from all of the pressure on their very limited incomes.”

Seeing the impact of their work will not happen overnight, Lovelace noted. Many social determinants of health initiatives are deemed failures because their measurement period is too short.

“It just takes a long time to turn the ship. In housing, for us, we don’t really see big changes until about eight, nine, ten months. Then people resettle themselves,” Lovelace concluded. “That’s where we see the impact. You have to wait long enough, and you have to know what you’re looking for.”