Why Invest in SDOH?
For health systems and physicians, understanding the patients you are treating should go beyond doctors’ offices (and most recently tele-visits). In the pilot results from the Health in Community Survey (HCS), more than one-third of respondents reported that they do not have enough resources for food, transportation, and covering medical bills, while 41.6% reported their primary care doctors were rarely aware of their struggles.10
Having SDOH data informs providers to consider other challenges patients are facing that could deteriorate their health, and create treatment plans closely aligned with patients’ social needs. For example, a primary care provider’s lack of understanding with respect to patients living in poverty can result in prescribing unaffordable medications, which inevitably leads to medication non-adherence and worsening of patients’ health.
Given the structure of value-based payment models, Accountable Care Organizations (ACOs) are encouraged to address SDOH. As ACOs are paid based on outcomes and savings, it is in their interest to undertake SDOH related interventions. Common social determinants ACOs address are transportation, housing, and food. Nonetheless, ACOs face challenges when integrating SDOH interventions into care management.
Study results indicate that the scarcity of data on patients’ social determinants and available community resources hinders ACOs’ ability to take actionable steps.10 Further, most partnerships between ACOs and community programs are in early developmental stages and have not shown promising results. Concerns over the time it will take to see the return of investment also slow down ACOs’ plan to implement SDOH intervention.12
Investment in SDOH enables payers to optimize network design, improve network performance through better allocation of resources to address specific social needs of specific populations.
As the Center for Medicare and Medicaid Services (CMS) moves to tackle SDOH, Medicare Advantage (MA) plans are allowed to provide coverage of supplemental benefits to chronically ill patients. The program, Supplemental Benefits for the Chronically Ill (SSBCI), covers a wide range of items and services to address chronically-ill patients’ SDOH, such as air conditioners, meals, counseling, and home remodeling that will improve or maintain the health of the beneficiary.13
A systematic review of the literature examining the effectiveness of investments in care interventions that integrate social services indicates that 82% of these investments resulted in a statistically significant impact in improving health outcomes, reducing care costs, or both. Program investments in housing, income, food, coordinated care, and partnership with community resources show positive impacts on health outcomes and decreased health spending.14
While it may take longer than expected to see the positive return on SDOH investments, evidence has shown the effectiveness of SSBCI. Humana’s Bold Goal program, which addresses individuals’ physical well-being as well as SDOH, reports that their MA members have seen improvement in population health and a decrease in Unhealthy Days (Unhealthy Days measures patient self-reported physically and mentally unhealthy days over 30 days).15 If you want to learn more about SSBCI, click here to replay CareJourney’s webinar, the Personalized MA Era: Optimizing Supplemental Benefits for Chronically Ill Beneficiaries (SSBCI), featuring Caroline Coats, Vice President of Humana’s Bold Goal & Population Health Strategy.
For Life Sciences
Life sciences also play a pivotal role in SDOH.
Integrating SDOH data into the workflow can tremendously benefit life sciences stakeholders in assessing potential market expansion opportunities by identifying unmet social needs and health conditions that largely hinge upon social determinants of the population of interests.
For existing markets, leveraging SDOH data can aid life sciences to evaluate medical non-adherence caused by social determinant attributes, and identify strategies to close the non-adherence gap. An analysis projects that medication non-adherence potentially results in a $250 billion loss in revenue for U.S. pharmaceuticals.16
SDOH are the main predictors of medication access barriers.17
Patients living in rural areas have increased difficulty in access to medications. Patients living in disadvantaged communities with no vehicles face barriers to refill their medications on time. For patients whose first language is not English, they may face challenges sticking with their medications ascribed to confusion about the medications caused by language barriers.
It is in life sciences best interest to invest in SDOH and capture lost revenues in medication non-adherence.
Medication non-adherence also presents opportunities to pharmacies within distressed communities to partner with local providers and healthcare stakeholders to address SDOH. Through analyzing Medicare Part D prescription claims data of each individual pharmacy in the country, CareJourney’s recent blog, Opioid Epidemic, Part 2: The Pharmacy Impact, discusses the decisive influence pharmacists play in the opioid crisis and how different segments of the healthcare industry should collaborate to understand patients’ total health of care.