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Addressing Social Determinants of Health to Drive Member Retention, Outcomes
January 31, 2017

Addressing Social Determinants of Health to Drive Member Retention, Outcomes

Lisa DiSalvo is senior vice president of product strategy and development at Altegra Health, a Change Healthcare company.
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:
  • Start small. The most fundamental step for plans just getting started is to broaden their notion of case management to consider factors outside of traditional healthcare needs. If a plan has yet to begin assessing and stratifying members based on social determinants of health, starting small is key. For instance, begin by targeting a specific social need or demographic such as those with lowest income or most frequent emergency department visits.
  • Analyze the value and meaningful impact of existing programs. Plans with social determinants of health programs currently in place should assess performance based on value to the member’s need and location. For example, geographically inconvenient programs or those with overly restrictive requirements are less valuable than those directly impacting daily living, such as utility assistance and food support. Plans can create a “value score” for programs to assure the best value for members, identifying key areas including: health and healthcare, economic stability, education, social and community content. Then, plans can tie attributes to those programs, considering specifics such as the program’s essentialness, benefit frequency, accessibility and capacity limits.

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