Addressing Social Determinants of Health to Drive Member Retention, Outcomes


As the healthcare landscape continues to evolve, the shift to value-based payments is reframing the paradigm for lowering costs while increasing care quality. With considerable evidence that interventions aimed at social determinants of health can positively influence health outcomes and costs, the discourse is changing among providers and policy influencers to look beyond disease and clinical conditions and address the environmental factors that impact our healthcare system.
 
Managed care organizations (MCOs) can play a pivotal role in this shifting model by focusing resources to partner with providers and the community—addressing social determinants of health. The benefits of these efforts extend beyond reduced care costs to include member retention and improved provider satisfaction.
 

It’s Time to Address Social Determinants of Health

States continue to protect Medicaid budgets with increased growth in managed Medicaid. Additionally, CMS and health plans are increasingly shifting provider contracts to value-based structures such as accountable care organizations or Merit-Based Incentive Payment Systems and/or Advanced Alternate Payment Models as outlined in the Medicare Access & CHIP Reauthorization Act of 2015. These new contracts exacerbate providers’ struggles as they relate to environmental factors affecting their patients. In fact, 80% of physicians feel ill equipped to address patients’ social needs despite understanding that they can be just as critical as medical needs. By proactively working with contracted provider groups, MCOs can drive meaningful improvements in both healthcare costs and member care.  
When MCOs extend their support, members respond with increased loyalty, translating to greater retention and less member churn. In fact, the Health Affairs blog notes that 69% of patients are more likely to recommend a healthcare organization that assists with access to basic resources. A study by Altegra Health released data showing that Medicare Advantage plans increase average length membership by 21% when members are screened and receive support for social and community-based resources.
 

Proactively Addressing—and Impacting—Social Determinants of Health

Organizations lacking a sound plan to address social determinants of health or those who wish to improve their programs should consider the following steps and strategies:
Print | AJMC Printing...