Using a data-driven approach to human-centered SDOH work

Transcript - Using a data-driven approach to human-centered SDOH work

Roy Beveridge: Having this significant database treat the people and acknowledge the people who are not sitting in front of you. That's the trick. That's where data becomes really important.

Sarah Ahmad: Sometimes we make data so impersonal. Data is very personal, that data is telling us so much about that community, about the people that live in the community,

Kelsey Waddill: The healthcare system is still figuring out how to incorporate social determinants of health data effectively. Sarah Ahmad, CEO of CAQH, and Dr. Roy Beveridge, managing director at Avalere Health, spoke with our own Sara Heath, executive editor at Xtelligent, about the intersection between healthcare's data efforts and the demand for better social determinants of health and population health solutions. This conversation is a prelude to our 2024 Payer+Provider Virtual Summit, taking place Nov. 12 through 13. If you like what you hear in this episode, register online to hear more by going to xtelligentvirtualsummits.brighttalk.com and clicking on Payer + Provider.

Sara Heath: Thank you, guys, both so much for joining us this morning. I think that this should be a really fun and interesting conversation. To kick things off, Dr. Beveridge, do you want to talk a little bit about some of the specific barriers to healthcare access that you observe in underserved populations and how do these manifest in clinical settings?

Beveridge: When I started practice, I would see patients, I would see them in the clinic and I'd get upset when a patient didn't show up for an appointment with me. I would say something like, 'You have diabetes. Come back in three weeks. I want you to take these medicines and then we're going to start your treatment.' And then the patient frequently wouldn't show up, the patient showed up late, the patient was unprepared, hadn't filled her medicines. And I remember being irritated. And it took a long time to realize that the reason that this person was late was because she had a whole bunch of problems at home, which precluded her from coming to see me on time. She had to take three buses to get to my clinic. She had grandchildren to take care of. She had a very, very complex set of circumstances, which I was completely unaware of.

And now I think what we've begun to understand, and we label as the social determinants of health, is that there are a whole bunch of things that are really important to understand if someone's going to have good healthcare.

Heath: Absolutely. And on this topic of just social determinants of health, obviously thinking about some of those more interpersonal factors is really important, but all of that can translate into different health data points. Sarah, I was wondering if you could describe how data analytics has helped healthcare systems identify the barriers that Dr. Beveridge just described and how to address some of these barriers in real time?

Ahmad: Before I go to that, can I jump back to something Dr. Beveridge mentioned?

Heath: Yeah.

Ahmad: Understanding or learning about the person, who they are, what they're going through in their life, and having the empathy for that person so that you can help personalize their care is so important in medicine today, but it's so hard. Providers are taking on so much. There's so much administration hassle. There's just so much burden. And so we say that, but in the reality of it is how do we ever expect caregivers to do all that? It's a lot to take on.

And then you think about the people involved, whether it's someone that is facing some significant social determinants of health issues, or even a woman trying to get through menopause and perimenopause. We had an amazing session on the opening day where we had a number of people on the panel talking about women and what we're going through as aging women. And it's hard to juggle life, your career and all the things that go into just being a mother and a businesswoman. And so, that's just one example of a person who needs special care, special attention, special understanding. And we expect providers to do that and to be able to respond to those needs.

So, when you sum it all up, when you think about providing care in the United States, and whether it's a doctor or a physical therapist or a nurse practitioner, all these providers, not only are they having to personalize every interaction to deliver the best possible care, they also have to take care of themselves too. And so, I think it's a lot that we put on providers today and we all need to be cognizant of what they go through. And even when you try to do your best, there's going to be moments that you're not going to be able to deliver that best care for each individual, but damn do they do a good job trying.

Beveridge: But I think that's part of the discussion, which is marrying the technology with the human component of this, in that healthcare is complex. It takes us 5, 6, 7 weeks sometimes to get an appointment with our general physician. You see the physician for 12 minutes, maybe 10 minutes, they give you a prescription and then there's an expectation of you fulfilling what they have requested.

And the practitioners, the providers don't have the time nor do they have the information, nor do they have the aptitude. And I think that's really important to realize that it has to be something which is diversified throughout the system in terms of social determinants of health, working with the patient, and understanding what they can get and where they are in terms of their understanding.

Ahmad: Absolutely. And on the insurer side, to prepare for that session that first day, we ran a lot of data. We ran census data, we ran some data from NPI, we ran our own CAQH data, because we hold the most provider data in the United States with regards to provider records, who the provider is, where they went to med school, where they're located, where they did their fellowship, their residencies.

We took all this data and we took a look at some also trends in the United States. And we found by 2030 just say, OB/GYNs, there's going to be a 5,000 OB/GYN shortage. So, you think about the access issue just with that one specialty that we're going to be faced with. It's a huge issue, for sure.

Beveridge: But it exists, Sarah, already in so many parts of rural and nonurban, non-suburban America. There are very large numbers of ZIP codes where there's not a practicing obstetrician.

Ahmad: Yeah.

Beveridge: And this is a problem.

Ahmad: Yes. And this is where the data comes in. So, our ability in the United States to identify where those gaps exist is totally possible. And a lot of insurance companies do this really well, doing network adequacy, maybe not so much to do what we're talking about, to identify those gaps in care and to make sure that you're filling that rural community with the right providers based on what's going on with the people in that community. But also just to meet the regulatory requirements of network adequacy.

Beveridge: Sure.

Ahmad: But the data exists. And being able to take that, understand where those gaps are in the United States, and then partnering with medical schools, partnering with residency programs, ensuring that we're filling those gaps with the types of providers that those communities are seeing the shortage of is so important in the US today. And it's so possible because the data exists.

We have the data, we have it at CAQH. We need to be doing more of this network analytics to understand where this problem is occurring, because it's only going to get worse if we don't get in front of it.

Heath: There was recently a lot of data coming out about different maternity care deserts, so as you guys were talking about lack of OB/GYNs in certain counties, I was like, 'Oh yeah, I covered reports about that recently. So, I know exactly what you're talking about.'

I wanted to recenter the conversation a little bit on some of those social determinants of health that we were talking about. Obviously, uncovering social determinants of health requires a lot of patient-provider communication and empathy and trust and all of those important things, but it's also critical to make sure that information is stored somewhere and that it's documented so that a provider can continue to understand that about a patient throughout multiple different encounters.

And I was wondering if we can talk a little bit about some of the data analytics systems that are necessary to help health systems flag some of those social determinants and then design some of the different interventions that can help fill in different SDOH barriers along the way for patients. I'm not sure who might be more excited to talk about that. You guys could …

Beveridge: We're actually both excited.

Ahmad: We're both excited.

Heath: Oh, excellent.

Ahmad: Because Dr. Beveridge and I spent some time together at a company where we were incredibly invested, and I still feel personally invested in understanding the social determinants of health across the country. And we were part of an effort to get after that data and to get very clear on where the biggest problems exist and the barriers of health exist in each of the communities that we served at our prior organization. And that all started with the data. Very deep data mining that our very advanced analytics team was able to get after because we took a look at it through the lens of the demographics of the community, but also using our claims data to identify very predictively and proactively what was going on in those communities from a disease progression standpoint.

I have never been more proud of the analytics work that I've done in my career as I did back with Dr. Beveridge, because we went incredibly deep with different cohorts of patients based on their diabetes, their COPD, their cardiovascular disease, and we were able to take a look at that journey that those patients went through, the different changes in their diagnosis from prediabetes to more advanced diabetes. The issues that they experienced as a person and the implications of that disease progression going to the ER or encountering diabetic retinopathy as the disease progressed. We were able to see that in the claims data and then marry that with demographics to start predicting in different communities where we would see the advancement quicker.

And so, I was very proud of this work that we did because then we went into that community and took action. We had solutions. We had digital therapeutics. We had education programs, whether it was for diabetes or COPD. So, that was something that I saw happen in the real world and it was incredibly effective because we did reduce disease progression in some of these conditions.

Beveridge: I think the most important thing is to recognize that this social determinant thought is not purely an empathetic, nice thing to have. It's an economic necessity if one wants to treat patients and populations of patients.

So, if someone has problems with transportation and they can't see a specialist and they've got a problem with a surgeon or someone else, they're not going to get there because they can't get there. And so, you can spend a whole lot of time, and from a societal standpoint, it's expensive if the patient does not go see the specialist. And so, this is not a nice to have. It's a requirement if you're going to take care of patients.

And so, it's important that people not dismiss this whole topic and just say, 'It's giving the patient the medicine and making sure they take it that's the important part.' If they can't get to the pharmacy and they can't pick up their medicine, or they don't understand because of a language issue, it'll be taken wrong. And then there can be more complications, which is more expensive for society as a whole. So, as I said, this is a requirement, not a nice-to-have.

Ahmad: So, about 10 years ago, I had the incredible opportunity to be exposed to this world of human-centered design when I was part of the innovation team at Humana. And I did not understand at the time how important it is to learn about the individuals that we were providing care for and to design for their needs, not the needs of the organization that you may work for.

And we had exposure to this design thinking, which I carried over into another role when I went over to Highmark Health, and we built a design practice team to help the care delivery system in Pittsburgh at Allegheny Health Network. And one of the projects that we worked on was designing the new cancer centers. They were regional, in the community cancer centers, but also the academic cancer center at Allegheny General Hospital. We were designing the experience in the center, but what we failed to do was design outside of the center. So, the transportation, how did they get there? How close to the front door was the bus stop? Did we make room if they needed to take a taxi? What was the experience just to find the parking lot?

Because in that moment that someone is going back for a follow-up, whether they've already been diagnosed with cancer or they're going to get information about whether they have cancer or not, making it easy for them through that sometimes horrific personal experience is incredibly important. And you sometimes take it for granted that full journey, that full experience that they go through. And so, we went back and redesigned it, so we made it easier from the moment they thought about having to go to that appointment, that transportation, that entering that door, even where the bathroom was located, if they needed to go cry when they got that diagnosis. All of that needed to be thought through. It was an incredibly important part of my career and hopefully we did some really incredible work for the patients that we served.

Beveridge: The reason that I think population health is so important in this discussion, when you start thinking about the marriage of data and systems with the care of people, is that it's very easy to take care of a sick person. Someone's got a heart attack. It's complicated, but it's pretty straightforward. The complication comes with how can you treat the person before they have their heart attack? So, how can you treat the person who's not yet sick? There's sick care and there's healthcare. Sick care, simple, relatively. Healthcare is maintaining health, improving health, preventing some sick care.

And that's where data, all the what you were just talking about, is so important in terms having this significant database and understand how this is important in the progression that people are going to have, and to treat the people and acknowledge the people who are not sitting in front of you.

Ahmad: Yes. Yes.

Beveridge: That's the trick. That's where data becomes really important. Is that how you think about it?

Ahmad: Completely agree. Completely agree. I think sometimes we make data so impersonal. Data is very personal. That data is telling us so much about that community, about the people that live in the community. And we have to start also using different sources of data. It's important that you use the claim data, you use the clinical data, but what else is going on in that community? What's happening in the news? What's happening day-to-day in that community? You've got to take all that and you've got to synthesize it to truly get what's happening in that community to be able to treat that community.

Heath: Yeah. That actually segues really nicely into the next question I was going to ask, which is about integrating some of these more non-traditional data sources and how it can enhance our understanding of these social determinants.

Maybe if you could identify different examples of some effective non-traditional data sources, but also how do we integrate? Because when we're talking about data, we all know that interoperability and data exchange is definitely a hurdle. So, how do we make this work?

Ahmad: So, when we were putting together a diabetes program about 10 years ago in the city of New Orleans, it was an education program to help people learn about just basic food knowledge and knowing what to eat to help them manage their diabetes, potentially slow that progression. But we wanted to dig into the data related to food purchases, what's going on at the grocery stores? What are the trends that we're seeing in the community in New Orleans?

We wanted to also see what was going on in the community with regard to church and other organization participation. And so, we started digging into pieces of data that normally you don't consider. You actually use that data to understand what's happening in that community from the spiritual level to the food level, just to better know them. And so, that helped us when we designed that education program, the language we use, the terms we use. The ethnicity of the people in the population and being able to speak their language was incredibly important.

So, we took all of these different nontraditional sources of data, and we used that to develop a program that we believed was the most engaging for those people, because we did care enough to know them and to get close to them and to be part of their community as well. Are you speechless?

Beveridge: No. That's exactly right.

Ahmad: We did that.

Beveridge: Yeah, we did.

Ahmad: Yeah, we did some really cool things.

Beveridge: But I think that just to keep harping on, it's not just the data, it's the deep understanding of what it means. And there has to always be a personal element in this. So, an example that I like to use would be if you look at someone's refrigerator and if they don't have food in it the day before they go off to have hip surgery or some type of abdominal surgery, the chance that they're going to be readmitted to hospital is really high. But it's not because it's just that they're hungry. It's because they might have significant problems economically, so they can't fill the fridge, or they may have transportation problems and can't go out past the food desert to get food, or they may be depressed.

And so, you can get the data, but then you have to go into it deeply and understand. So, just giving someone some food when they get back from a hospital is not necessarily the answer. It might be the end result of something more complicated. But you need to understand that, because if it's someone who has a problem with transportation, that's one solution. But it could be they've got early dementia and they just forget to go out. That's a completely different thing that you need to be aware of if someone's going in for surgery. And that's why the data that we as a society are beginning to collect, and are collecting, is so vitally important.

Ahmad: So, to add on to the nontraditional sources, I think there's been many studies now about social media and the interaction that people have with their social media. They run the data. They know if you're depressed. They know if you're on a high or you're on a low. It's there based on your interaction and your posting and what you're saying.

What's interesting now is I can even tell. I can even tell. When my mom's posting a lot more or a lot less, I know how she's feeling now, not because I talked to her today, because of her posting on Facebook. And it's absolutely amazing how you can actually see that. So, it's just being in tune with it and being cognizant of it. And sometimes it's not even about accumulation of a large amount of data, it's just being aware.

Beveridge: Data sources are, as you've been asking questions, are exactly spot on. But the other point that it brings up is that in order for one to successfully take care of a population of people or an individual, you have to have engagement. So, getting back to what you said earlier, which was empathy. Correct. There has to be some connection, some engagement, because if there's no engagement, you're not going to get those vital bits of data uptake that are required.

Ahmad: And to me, that is the biggest problem in healthcare.

Beveridge: Engagement.

Ahmad: I don't think anybody's cracked that, not yet. I've done so much work from the HumanaVitality days to the work I did in Canada with Shoppers Drug Mart, with PC Health, engaging in that technical solution to help people with their health and wellness.

I still believe that engagement requires high personal touch. I still believe that the physician, the nurse practitioner, any care provider is the best way to engage a patient, having that relationship, even a pharmacist. And if we don't continue to support clinicians to give them the time to engage in that way, we will fail as a society in delivering the best care and helping people with their disease progression.

Beveridge: There are multiple examples of primary care groups who have employed people from within a cohort, very analogous, consistent with the patient population they're treating, and have much higher engagement scores. When you're engaging people of like economic and societal understanding, that's important. It doesn't have to be the doctor or the nurse practitioner or the pharmacist. It really can be social worker or a community activist, community person who understands the environment, the population. I think there's a lot there.

Heath: Absolutely. And you started talking about these community health workers and maybe non-MD or non-RN people who are working within the health system. And I was wondering if we could talk about the impact that community health workers and similar types of healthcare professionals have had on bridging gaps between healthcare providers and underserved populations? That would be very interesting to hear.

Beveridge: I don't think it's just underserved populations.

Sara Heath: Yeah, very fair.

Beveridge: I think it's all populations. I think one needs to understand the population that you're serving. And frankly, if you see an oncologist for treatment of your primary breast cancer then you're not engaging someone who's maybe necessarily the most empathetic person. You want that person to tell you what the best data is for understanding how you should be treated. So, we should not expect that the physician necessarily is the most empathetic, engaged person.

We need to set up a system with data and with support, to have the patient engage the system that is as easy and able from her perspective. And that's where a lot of the data has to be used in terms of, what's the best way of communicating with this person? Does this person want to be communicated by text, by social network, by real personal engagement? That's the trick that we need to get to for the engagement that you've so astutely pointed out.

Ahmad: When I hear the term community care worker, or even when I say care provider, I'm not always talking about a physician or a clinical care provider. When I talk about a care provider, I'm talking about the best person to provide the type of care that's needed in the community for that person. So, that care might be behavioral health care, that care might be physical care. Sometimes that behavioral health or that support care could come from a friend, could come from a family member, a pastor, your neighbor.

There are people in this world today providing amazing care to their friends and their neighbors and to their family. And I think sometimes we forget about that. I think we forget that we're all potentially taking care of aging parents. We are care providers. And so, I do believe in clinically trained providers of care and the amazing support and care that they provide every day. But let us not forget that there are a lot of people in this world that aren't clinically trained, that are providing amazing care to the people they love. And I think when we talk about care provider, it goes much broader than clinicians, but we can't do it without the clinicians. It's got to be a partnership.

Beveridge: If you start thinking about segmentation of the population and how you engage people. If you think of a young woman on Medicaid with a child, that's a really tough life. They're struggling with food, with their employment, with all the social issues that they've got. Their engagement, from the studies, is much, much better with text. They like the asynchronous texting. Get it. Let's say you have a 70-year-old woman, texting is not the answer.

Ahmad: Except my mom.

Heath: Yeah.

Beveridge: That's what's so important in terms of this segmentation and understanding the data.

Ahmad: Yes. Yes.

Beveridge: Because there's not one solution that fits all, and that's where the data comes in.

Ahmad: Yep, absolutely. Knowing the person. Knowing the community.

Beveridge: Correct. Correct.

Ahmad: Knowing what's going to work best for them. I do want to leave you with one little story because this panel that we did, the opening, there was a focus on women's health and obviously I have a little bit of a passion about this, especially aging women's health. We don't give enough credit to those providers that we don't normally think about giving care.

And so, I had this amazing experience with a nurse practitioner. And Roy, I think I have a little bit of a bias toward physicians, and I just absolutely value what a physician does every day, their training, what they've gone through to get there. But I will tell you that nurse practitioner, that was the best care experience I've ever had. It was a coordinated, thought out, comprehensive visit that I had for my annual exam, I never knew existed. Mammogram, cervical, cancer screening, bone density, a consultation with her that went from physical to behavioral health as well. She was absolutely there for me.

And I now appreciate that broad range of care providers. I don't have to go see only my doctor. I still want to have a relationship with my primary care provider. I need that relationship. But what I experienced with this nurse practitioner was the best care I've ever had.

Heath: Oh, that's awesome to hear. Thank you guys both so much for joining us today.

Ahmad: Thank you.

Waddill: Thank you to Sarah Ahmad and Dr. Beveridge for coming on to today's episode, and thank you, listener, for tuning in! If you liked what you heard, head on over to Apple or Spotify and drop us a review. We will be choosing some of our reviews to be read on the show in appreciation, so keep listening through to the end, because you might get name-dropped. Don't forget to sign up to join us at the 2024 Payer+Provider Virtual Summit. Visit xtelligent.virtualsummits.brightalk.com. to register. See you there!

Waddill: Music by Vice President of Editorial Kyle Murphy, and production by me, Kelsey Waddill. This is a TechTarget production.