Why SDOH buzz is becoming a roar among health plans

By | June 24, 2019

There was nary a session at the annual conference of America’s Health Insurance Plans that did not include a mention social determinants of health.

Whether it was from the stage or on the show floor, there was widespread acknowledgement that these determinants are crucial factors in achieving the best health of a wide variety of individuals.

It’s not that SDOH is completely new to health plans. Several have been working on projects to address how these factors–whether it is lack of transportation, inability to access high-quality food, socioeconomic factors, or challenges such as social isolation and loneliness–impact health.

And it’s certainly not that there hasn’t been inordinate buzz at a healthcare conference before, and buzz can lead to over-the-top hype, and thence on to hyperbole. But my sense was that this was something different.

The broad interest of a wide variety of health plans in SDOH seems to run counter to the belief that health insurers haven’t cared about initiatives that would bring long-term improvements to the health of members, because those members might be in different plans by the time their health improved, and so a health plan wouldn’t derive benefits from investments in members’ long-term health.

The current reality of healthcare has changed all that. For some health plan member segments, plan switching rarely occurs, such as for populations in Medicare Advantage plans or those who are Medicaid dual eligible. Health plans are upping services to employer groups, working hard to retain contracts. The name of the game is getting and keeping members. In these scenarios, it pays to pay attention to factors that demonstrably impact health over the long term.

And an increasing body of evidence suggests that meeting SDOH health needs of members can have an immediate impact on health. Anecdotal evidence was everywhere. For example, Ghita Worcester, senior vice president of public affairs at UCare, shared the story of a 70-year-old woman who was only able to buy food out of vending machines, because she lived in a food desert in the Twin Cities metro area in Minnesota; additionally, she was pre-diabetic and was on seven medications. But access to healthful food caused a dramatic difference; she lost 73 pounds, was no longer at risk for diabetes and went to only one medication.

Those kinds of results, multiplied over large numbers of members, is the stuff of reduced avoidable costs for healthcare and better health for members. Well, lookie there–it’s a microcosm of how to succeed under value-based care.

But as health plans dive into addressing these social determinants, they are finding out that they involve more than offering transportation vouchers, offering food or education. Approaches need to be nuanced and personalized to the needs of individual members, providing support in a way that will be welcomed and effective.

For example, in the Twin Cities a UCare program aimed to provide education on the intricacies of the U.S. healthcare system to Sudanese immigrants, who were more likely to wait until medical conditions to the point where they needed emergency care, eschewing care from primary care physicians who could have headed off worsening conditions. However, the same approach was not as effective with ASIAN women, Worcester says.

Disseminating lessons such as those is one of the key motivations behind AHIP’s Project Link program, which hopes to gather knowledge on health plans’ experience with SDOH initiatives and allow that information to be shared across the industry.

The push to address social determinants will require put a premium on information technology, which will be needed to gather non-clinical information, analyzing it and making it actionable within workflows It will place new demands on systems, requiring them to be able to assimilate diverse types of information and integrate them with clinical records systems.

It is encouraging to see wider emphasis on SDOH and the impact that these factors have on health across populations. Now, the hard work begins. The answers, those possibly hard to find, have the potential to make a huge impact.

More from this Author


For reprint and licensing requests for this article, click here.


Health Data Management: Feed