Social Determinants Trend at AHIP’s Medicare, Medicaid Conference
Health plans and providers at AHIP’s National Conferences on Medicare and Medicaid are seeking methods for using social determinants of health to improve patient outcomes.
Source: Thinkstock
- WASHINGTON DC – Social determinants of health has emerged as a major theme at America's Health Insurance Plans’ (AHIP) National Conferences on Medicare, Medicaid, and dual eligibles in Washington DC.
Health plan leaders, providers, and other stakeholders can expect to hear industry experts address how payers and providers alike can gather and leverage data on social determinants of health to improve the care of their beneficiaries and patients.
With about one-third of all patient deaths directly attributable to social determinants, healthcare stakeholders are attempting to find methods for acquiring more information on social, behavioral, and environmental factors that contribute to health outcomes and using the data to create appropriate plans.
But payers and providers alike are encountering significant challenges with finding and using the information. Addressing social determinants of health has not been systematically incorporated into healthcare workflows, especially under fee-for-service payment structures.
As risk-based contracts demand that providers and payers treat the whole individual, not just his medical needs, stakeholders must overcome data collection challenges. The information is typically found in coded and unstructured EHR data, meaning plan leaders and providers must sift through the information to glean insights into social determinants of health.
READ MORE: Good Data, Better Value-Based Care Can Boost Population Health
Once stakeholders acquire the right information, payers and providers should also expect to develop stronger community-based resources to address social determinants of health, such as housing instability and healthy food access.
Addressing social determinants of health is a daunting task for healthcare stakeholders, but industry leaders at AHIP’s National Conferences on Medicare, Medicaid, and dual eligibles aim to help payers and providers navigate this journey through the following sessions.
Leveraging Ambulatory ICU Delivery to Improve Outcomes and Reduce Costs of Care for Patients with Complex Needs
Executives from AbsoluteCARE, Inc., a medical home targeting the complex chronically ill patient population, will kickstart the Medicare conference on Sept. 25 by exploring a care delivery model that focuses on social determinants of health.
AbsoluteCARE, Inc.’s CEO Alan Cohn and the organization’s Executive Vice President Gregory P. Foti, MD, plan to discuss how the current primary care system does not support the care needed for high-risk patients who account for between 30 percent and 40 percent of all paid claims.
Through an ambulatory intensive care unit delivery model, payers and providers can address the factors that contribute to the patient population’s elevated risk and high healthcare costs. The factors that the care model targets are social determinants of health, addiction, and behavioral health.
READ MORE: How Social Risk Factors Influence Value-Based Reimbursement
The executives argue that overcoming the challenges of these factors can help payers and providers reduce unnecessary healthcare utilization and spending.
The care model also aligns with value-based purchasing efforts that aim to improve care quality for the high-risk, chronically ill patient population.
Implementing Data-Driven Strategies to Address Social Determinants of Health
On Sept. 27 at the Medicaid conference, a breakfast briefing will examine data-driven approaches to gathering and leveraging social determinants of health data.
Manik Bhat, Co-Founder and CEO of Healthify, will lead the session. He plans to cover how healthcare workflows under fee-for-service payment structures do not support payers and providers as they look to address social determinants of health. The challenge has created obstacles for the stakeholders as they attempt to shift care more upstream.
Payers must now leverage health IT to meet the social health needs of beneficiaries, especially under value-based purchasing models that aim to reduce unnecessary utilization. Bhat plans to explain how payers can achieve value-based care goals by focusing on health issues at their source: the member’s social and community level.
READ MORE: Creating a Population Health Management Operating Model
Payers will need strategies that rely on data and data analytics tools to fully understand the impact social determinants of health have on member populations.
Plan Innovations Impacting Social Determinants of Health
Later on Sept. 27, AHIP will bring together representatives from Kaiser Permanent and UPMC Health Plan as well as CareSource, a non-profit managed care company. The panel plans to cover how their organizations are using social determinants of health data to better manage their member population.
The session will focus on three specific social determinants of health: housing, food, and employment. The industry experts will share how their organizations are using these social risk factors to impact health and outcomes while linking care management and health services.
The Humanization of Health Care: Addressing Social Determinants of Health to Improve Behavior Change
The final session on social determinants of health at the AHIP conferences will focus on developing care models for vulnerable populations.
On Sept. 28, two industry experts plan to discuss how payers and providers can overcome care access barriers brought on by social risk factors for pregnant women and children. The panel will be led by Mary V. Mason, MD, MBA, FACP, Executive Vice President and CMO of Envolve, and Debra Haire-Joshu, PhD, MS, MSEd, Joyce Wood Professor at Brown School and Evolve’s Director at the Center for Diabetes Translation Research as well as the Center for Obesity Prevention and Policy Research.
The session will cover how stakeholders can educate their patients and beneficiaries to eliminate care access barriers and prevent future chronic conditions, such as diabetes and obesity.