Social Determinants of Health and Impacting Highest-Need Populations: Your Questions, Answered

Today’s payers and providers are integrating atypical factors—demographics, social status, and transportation issues—that influence a patient’s health and choices they are making. These organizations are taking steps to address societal determinants of health (SDoH) in their member programs, leveraging this knowledge for improved outcomes, population health, and value-based healthcare initiatives. At the AHIP-Sagility September 9 webinar Social Determinants of Health: Impacting Highest-Need Populations, attendees learned more about this focus from the Sagility MVP team: Tara Page-Haddock, RN, Strategic Product Manager of Population Health Management Solutions; Mary Jane Konstantin, BSN, MHSA, RN, Senior Vice President and Head of Population Health Management Solutions; and Donna Martin, Senior Vice President of Global Healthcare Business Development.

Our presenters took a pulse on automation, with two polls to measure adoption and implementation:

• For our first poll “Which best describes how my organization approaches social determinants?” 35% of respondents have programs to address issues at the patient level, with only 19% assessing for social barriers at patient level and 19% with programs to address social issues within their community. A total 27% of attendees address social barriers as they are able, but with no formal program.
• Our second poll asked, “Does your program have a systematic approach for face-to-face outreach?” with 57% answering “Yes,” and 43% of respondents with no formalized approach.

What does this tell us? By all webinar results, today’s healthcare organizations are increasingly building resources and strategy to address social determinants. Post the session, our subject matter experts shed light on our attendees’ most pressing questions.

Q1: What is the importance of the patient’s understanding about how to be a self-advocate? Is there is education of provider around that topic and the navigation into the payer systems?

Mary Jane A: Even for those of us who are covered under commercial plans, that level of navigation can be challenging. Take durable medical equipment, for example. A high percentage of individuals that we encountered in the Medicaid population are not able to access durable medical. I think that is just an example of the importance of this kind of navigation. We help members access third-party grant money, and help them answer to how do they get resolution to things like food and security and even navigating through the benefits that may be available to them. It can be a situation where that’s really all the member needs to start down the path of doing a better job of taking care of their own condition.

Q2: Are there concerns that data shared by RNs or nurses are less likely to build trust?

Mary Jane A: As a nurse, I do look at that and completely understand. People feel much more comfortable speaking to someone whom they feel understands their situation, understands their condition. We advocate for using culturally relevant community outreach workers.

Q3: How do we evaluate the effectiveness of our efforts?

Mary Jane A: Thank you for asking that question. It is important to continue to do the follow-up, and that is essential to how we measure effectiveness. A key focus for individuals with a social determinant is to get them compliant with their treatment again. I think there are two ways that you can evaluate effectiveness: one is to identify if that care gap stayed closed. Let’s start with a case of intervention with someone because they are coming up as non-compliant with a mission critical medication. To continue to monitor their medication appearance rate, we use proportion days covered, or, PDC, rate. If you are taking one tablet a day and a refill includes 30 tablets, are you refilling consistently every 30 days or so? We typically use 80% or better as indicative of compliance, and if somebody drops below then we consider them to be non-compliant with that medication. So one measure of success is do you get sustained compliance? Another measure of success is to go back to those individuals after you’ve intervened and, hopefully, closed that social determinant barrier, and ask them 12 months out – “Is this still an issue for you? Is your health stable? Are you experiencing additional transportation issues?” Revisit that and identify how successful the initial intervention has been. We have found that if you can stay in touch with those individual, even if it is just an outreach or an offer or help periodically, you should see a very high success rate. We have seen up to 95% of those with gaps where we’ve intervened, those gaps remain closed a year later. That’s an important measure of success.

Q4: Is there an ongoing need to cost justify the multi-disciplinary care teams and how have we gone about calculating the ROI?

Mary Jane A: Let me split that into two responses. First answer is no. I am wholeheartedly supportive of multi-disciplinary care teams. I started my career as a nurse, so I understand firsthand information I did learn in school and what I didn’t. I have tremendous respect for many other disciplines. One of the things that we focus on is to identify who the right resource is to appropriately address a problem. For example, if a member had a medication non-adherence issue and not symptoms, we would have a nurse or a pharmacist work directly with that patient. However, if the non-adherence issue was related to cost or it was related to cost or something like that, a social worker on our team would be much better at resolving that issue. So we think through how we match the skillsets of our team members with the specific root causes.

The second part of the question is calculating the ROI. I mentioned a couple of direct ways of measuring success. One is, when you close a gap, does that stay closed? The second is, for the presenting problem that results in non-compliance, are using for example, claims to evaluate? Both of those issues provide some terrific results, they don’t get into financials. As you start to speak about the true return on investment, you start to think about, what’s the purpose of compliance? If it’s an inhibitor prescribed to a 60-year old type 2 diabetic with hypertension, if that individual is non-compliant with that mission-critical drug, the likelihood that they are going to have a near-term exacerbation of their condition is quite great. If you are using predictive analytics and stratifying your population so that you can filter through and spot individuals with that kind of a situation, that is someone with whom you want to intervene. Then you are going to have to do some calculation about what would have happened if we hadn’t intervened.

Q5: What are the efforts to address oral health?

Mary Jane A: Thank you so much for asking that question. That is one of the areas that is often overlooked. I can only suggest an answer, and that is sometimes the benefits for oral health are separate from the other physical and mental health benefits. For that reason, organizations tend to be not as broad in their approach. But certainly the impact of oral health on physical health is extreme and thank you for raising that. I think it’s certainly something worthwhile to add into your mix if you are able to.

Q6: What about the difference in social determinants by geography – urban versus rural?

Mary Jane A: In our experience, very often, while the issue—such as transportation—might be the same, it manifests itself very differently. So in an urban environment, there may be more opportunities for transportation or they may be more obvious than they are in a rural environment. It’s all about how you or your team members need to think through how to solve an issue: housing, transportation, or whatever it is. The mechanisms that you use may be very different based on the population, but I think the issues are absolutely the same. We certainly see common themes come up regardless of whether we are dealing with an urban or with a suburban or rural population. We do have a program up and running in one if the richest counties in the United States, closer to an urban scenario, where the household income is phenomenal. Yet we see exactly the same issue that we see in some of the rural states.