How Social Determinants of Health Data Can Inform More Effective Care

Over the last decade, the triple aim has expanded from a focus on improved patient experience, better health outcomes, and lower costs to become the quintuple aim, including clinician well-being and, most recently, health equity. That latter emerged as a matter of great concern during the COVID-19 pandemic, with providers and payers strategizing how to address social determinants of health whose influence on a patient’s health status is 6 to 7 times greater than interactions with the healthcare system.

There is growing evidence that addressing health inequities and SDOH is imperative to counter escalating healthcare expenditures in the United States, which have recently exceeded $4 trillion annually (approximately 20 percent of the country’s gross domestic product). According to the Institute for Healthcare Improvement, health inequities currently are responsible for $83 billion in overall US healthcare spending and are projected to eclipse $300 billion by 2050. Unfortunately, these sizeable financial outlays have done little to curb preventable deaths.

As providers and payers have come to understand, viewing patients primarily through a narrow lens of clinical records and claims data has failed to reduce cost and improve population health across the nation. Instead, this approach has proved detrimental to the sickest and poorest individuals and communities who face numerous barriers to accessing, affording, and ultimately benefiting from the healthcare system.

Despite the outsize impact of SDOHs on individual health, many care management strategies and clinical interventions have targeted specific diseases and fallen short of addressing community-level health factors that uniquely challenge vulnerable populations to improve their health and well-being. Increasingly, a growing body of literature shows that interventions based on SDOHs and social needs can lead to positive outcomes for high-risk individuals. 

Early efforts to incorporate health equity by addressing social determinants of health have raised concerns about the incentives for various stakeholders, namely providers and payers, known as the wrong pockets problem. Simply put, participants from across the healthcare system — providers, payers, pharmacies and community-based organizations — contend that their resources and efforts around social needs do not lead to direct rewards for their respective organizations.

A shift in perspective is necessary to build momentum for health equity initiatives and ensure that participants understand that quality improvements in this area lead to shared benefits across the healthcare system. According to Andrea Green, RN, Director of Healthcare Strategy from LexisNexis Risk Solutions, a lack of coordinated effort between providers and payers to address health equity is more likely to lead to declines in reimbursement for the former and increased spending for the latter due to an uptick in utilization.

“A failure to act by the provider or payer can very easily lead to patients presenting in emergency departments and then being transferred to inpatient settings, which is costly for both parties. Providers will not receive readmissions within a given 30-day period, while payers will have to foot the bill when patients continue to be admitted. But more importantly, there is unlikely to be any lasting positive impact on a patient’s health and well-being,” she observes.

To avoid these costs and better serve patients throughout their care journey, providers and payers focused on addressing social must avoid taking a siloed approach and instead adopt a collaborative approach that benefits all parties — patients, providers and payers.

“It has to be a multipronged approach because no single organization can do it alone,” Green explains. “It has to be a concerted effort between payers and providers with the shared goal of keeping patients from expensive, high-acuity settings by helping them overcome obstacles in the way of prevention and self-managed care.”

The key to making these collaborative efforts effective starts with data to provide a 360-degree view of individuals and communities. Much of that information exists in silos that must be aggregated, analyzed and turned into decision support.

By leveraging a strategic partner to help connect the dots — in this case, data sources from employment and housing to transportation and education — payers and providers can combine these data points with their own and identify which resources are most likely to benefit an individual.

“The ability to stratify patient populations will unveil existing inequities and enable organizations to distribute resources equitably and improve the quality of care provided to patients and members,” Green explains.

Effective socioeconomic data use extends beyond preventive care and avoidable gaps in care. This information can fuel predictive models about an individual’s likelihood to adhere to a care plan to create personalized care plans that support efficient provider operations and avoid payer spending on ineffective approaches. At a population level, richer data that combines clinical and socioeconomic information can enable the healthcare system to better understand the health of entire communities and invest in programs that remove the most pressing impediments in the way of their residents experiencing a better quality of life.

As efforts to advance health equity are combined with changes in healthcare reimbursement, those organizations that invest in assessing and responding to the social needs of the communities they serve will be better equipped to thrive in a healthcare environment that rewards quality over quantity of services.

___________________________________________

LexisNexis Health Care helps providers meet interoperability goals and gives patients more control of their health data. Through proprietary linking technology and access to the most robust and accurate consumer data in the industry, LexisNexis helps to improve patient outcomes, provide market intelligence, protect patient identities, and enable compliance.