The health outcomes of your members depend on many factors. As a Medicare plan, you may only have direct control of some of those factors. Although you can provide members with resources and access to providers and medication, it doesn’t mean they are engaged enough to take action. Many times, you can only achieve progress by addressing social determinants of health (SDOH).
Medical care only accounts for 10-20 percent of the factors that impact the health of US citizens. The other 80-90 percent of factors relate to SDOH. These include health-related behaviors, socioeconomic situations and environmental factors. SDOH encompasses the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.
When your members experience uncertainty or volatility with food, shelter or other basic needs, they may not prioritize preventative care visits or engage in health improvement activities. In addition to these components, there is more recent understanding of additional SDOH factors which includes stress, social isolation and loneliness.
Medicare members are often at elevated risk for SDOH for several reasons. Members could have financial challenges, living on fixed incomes post-retirement. Additionally, they often encounter issues around transportation access, fears around safety at home (e.g., fall risks) and social isolation or loneliness.
Addressing social determinants of health with new strategies and approaches could positively impact health outcomes. Medicare plans have been pursuing this goal as they begin to realize the costs of not confronting SDOH, including shorter life spans and increased medical spending.
So how can you address social determinants of health to improve outcomes for your members?
Interventions exist, but barriers remain
A 2021 report acknowledged that Medicare Advantage plans dramatically increased activities to address SDOH. However, barriers remain.
In the report, one expert shared this opinion: “The barriers are that we have a system that is about sick care. It's about providing drugs. It's about providing hospitalizations and SNF visits … And yet we have clear proof and data that social determinants of health matter as much or more than those medical issues.”
The entire ecosystem revolves around medical care. However, the data supports that SDOH outweigh the actual delivery of care.
The study also notes three other barriers:
- Social services disconnect: A member’s social needs exist outside the health care system, which makes it difficult for plans to address them.
- Incentive misalignment: Payment rules complicate interventions. In most cases, funding exists only through grants or other public means.
- Technology woes: Data sharing is a major pain point in health care. Without timely access to data, coordination between providers and social services falters.
The report does provide recommendations for the Centers of Medicare & Medicaid Services (CMS) to bolster SDOH data collection, improve information sharing, authorize Value-Based Insurance Design (VBID) and modify Medicare Advantage risk adjustment and Star Ratings.
CMS has provided flexibility in coverage for benefits to address SDOH since 2019 by reducing the criteria for eligibility for these benefits. A PwC analysis found that Medicare members were most likely to cite depression and mental health concerns as top SDOH.
This finding makes it clear that Medicare plans must implement tactics that screen for specific SDOH and focus attention on mental health aspects, such as social isolation and loneliness.
To address SDOH, you must start with identification
To address SDOHs, you have to know they exist. A recent study of women diagnosed with gynecologic cancer showed how health systems could do this accurately. SDOH screenings were implemented to help providers understand what was happening outside of care delivery. The result of the screening was that women had at least one—if not more—unmet social needs.
Many of these patients related their distress to social isolation and feeling unsafe at home. Additional causes were lack of access to transportation, food insecurity and housing instability.
Considering these women were from low-income populations, there was also care disparity at play. The researchers concluded that identifying needs and developing interventions to mitigate them would affect treatment outcomes.
There are many tools available for SDOH screenings, and you can collect data via technology or manual means. Manual data collection is more complex and doesn’t provide much of an advantage. Conversely, using technology offers scale and efficiency. People who report SDOH needs may also be more inclined to answer questions in an app than be honest and vulnerable with their providers or plans care coordinators.
Examples of addressing SDOH
Addressing SDOH can improve health outcomes. Some examples include:
- Baylor College of Medicine’s Environmental Health Service works directly with patients to reduce environmental contributors to asthma in their homes.
- Legal assistance is available at the People’s Community Clinic in Austin, providing patients with housing, immigration and financial security support.
- Stephen F. Austin Community Health Network collaborates with the United Way to offer its network of social services on an online platform.
These case studies are featured in a report from the Texas Health Improvement Network. It provides specific recommendations that other health care stakeholders can take. One of its central points is the use of technology for screening and tracking SDOH.
Connecting members to the resources they need through screening and analysis can drive better outcomes. The examples above address various SDOH factors, but what about focusing on loneliness and social isolation?
The loneliness factor in addressing SDOH for better outcomes
When loneliness is a chronic condition, it can significantly impair a person’s ability to engage in healthy behaviors and adhere to treatment plans. It’s not simply a feeling, it’s a condition similar to diabetes and other health conditions. Instead, lonely people believe that they are all alone and do not have any social relationships to lean on.
When Medicare plans focus on loneliness as an SDOH, improved patient outcomes are possible. If you want to address loneliness, you must:
- Screen members with easy-to-use, friendly technology that provides actionable data.
- Deploy evidence-based treatments that mix technology and human connection to encourage members, connect them with resources and be a helping hand.
- Measure the impact of the treatment to understand its effect.
Learn more about how your Medicare plan can better address the loneliness factor by exploring the Pyx Health solution.
