Social determinants of health drive results
Tushar Mehrotra: Welcome to our discussion on Leveraging social determinants of health across the enterprise to drive performance. My name is Tushar Mehrotta, and I'm head of our analytic services business. I'm joined today by two of my colleagues, Jim Dolstad, vice president of Actuarial services, and Dr. Ali Shirvani-Mahavi, vice president of consumer analytics. Jim and Ali are two of our deep experts on this topic. We will be discussing insights that we are witnessing firsthand from the market and leveraging social determinants of health. Ali, first off, what is social determinants of health?
Dr. Ali Shirvani-Mahavi: Thank you, Tushar. Social determinants of health are conditions in the environments in which people are born, live, learn, work, play, worship and age that affect a wide range of health functioning and quality of life outcomes and risk. In essence, it is the fact that health starts in our homes, in our schools and workplaces, neighborhoods and communities. And by some estimates, social determinants are responsible for 60% of health outcomes, which is much more than genetics and access to health.
Tushar: Thanks, Ali. Jim, in your opinion, can social determinants be leveraged broadly in healthcare?
Jim Dolstad: Absolutely. Social determinants of health can be applied to all lines of business, commercial, Medicare, Medicaid and government, to drive improvements in both clinical outcomes and financial performance at lower operational costs across multiple business areas. By leveraging community, social economic and individual data that are typically housed outside of a payer's walls, the payer can then begin to understand their member, not just their patient. Practically speaking, it helps the plans that are data poor become data rich and those that are data rich become richer.
Tushar: Thank You. Ali and Jim, what are we learning so far? And where is there value in social determinants?
Dr. Ali: From the patient perspective, we are learning that social determinants create those barriers and motivators that impact a patient's behavior and how well they take care of themselves or how they follow the doctor's advice. For example, we know that access to healthy food is a big issue in some neighborhoods, and that impacts [unintelligible 00:02:26] people eat, which obviously impacts their health. Same with transportation, which impacts whether someone can get to their doctor appointment or get the support which has a significant impact on outcomes, and the list goes on.
From the provider perspective, it's really about meeting the patient where they are in terms of their needs and wants. There are cases where doctors have prescribed food for their patients, because that was the most important way to get them better outcomes. And although we are making great progress in this area, we are a long way away from truly understanding and removing those barriers that prevent patients from taking care of themselves.
Tushar: And, Jim, how about from a financial perspective?
Jim: All plans are always looking to improve the accuracy of their predictive models. We know most predictive models work best with twelve months of data. However, the reality at any point in time for commercial and Medicaid populations is that there's a huge gap in data. Often times, that gap is 30% to 45% of members having incomplete or missing data. Social determinants of health is going to be the fastest way to know something about these members other than just their age and gender, so that clinical risk can be assessed and acted upon as soon as possible. This is really important for Medicaid, where members have significant need and are on average only enrolled about nine and a half months.
Tushar: Thank you. Jim, lastly, what's the best way to get started using social determinants?
Jim: Relax Rays tend to be big believers in substituting demonstrations for impressions. Ultimately, seeing is believing, and many proof of concepts can be done quickly with results emerging in just a few months. There's lots of pilots that can be designed to solve emerging business problems. A couple of examples of pilots might be reducing hospital admissions through improved stratification of discharges by using a social isolation index, or another one would be improve forecasting of lapse trades for marketing and financial projections.
At the end of the day, we all know results matter and proof of concepts allow payers to test drive the approach.
Tushar: Thank you both for your time and insights. This concludes our podcast. If you would like to learn more on this topic, contact us directly or download our recent publications.
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