Payers Accelerate Investment to Close SDOH Gaps

As we’ve discussed before, 94% of our colleagues believe the current healthcare system revolves around sickness rather than health. But the majority of them also believe we’ll transform that dynamic within the next 10 years.

To be clear, their optimism isn’t based on pie-in-the-sky predictions. There’s evidence of the shift toward comprehensive health emerging all the time — with the investment cash to back it up. Yeah, it’s actually happening.

A recent survey indicates that 82% of organizations are designing strategies to address social determinants of health (SDOH). A growing number of them are training providers to capture SDOH data during patient encounters, and about 20% are coordinating their efforts with community programs and resources. (Change Healthcare)

Take, for example, Kaiser Permanente’s new Thrive Local network. It’s a community of healthcare and social services providers — integrated with KP’s electronic medical records system — who aim to address the need for housing, food, safety, utilities, and more. As the program rolls out this summer, KP providers will be able to connect their patients to helpful resources in the network.

KP leaders might have their work cut out for them. About 29% of the organization’s 12.3 million members face food insecurity, and 23% have housing insecurity. The outcomes data from this program will make for some good reading in the future.

A third party, backed by about $45 million in funding, will handle the Thrive Local referrals and track outcomes for KP.

Big Blues investment

Meanwhile, the Blue Cross Blue Shield Institute is also rolling out a national initiative that connects the insurer organizations and their provider networks to services aimed at improving SDOH. What’s interesting here is that a number of Blue plans have since invested $42 million in the third-party platform that’s shepherding the program. (Forbes)

The platform is managing patient identification and enrollment, reimbursement infrastructure, data crunching, and patient-facing engagement. Some of the challenges the Blues plan to tackle include food insecurity, transportation, falling accidents, and social isolation.

Unmet social needs double a consumer’s risk of incurring new or additional healthcare services. (McKinsey) Clearly these payers have a lot to gain by operationalizing member referrals to resources and by tracking and responding to the ROI along the way. No doubt returns will be a moving target.

Our Take: Strategies that improve SDOH are slowly evolving from nice, value-added features to essential services that are part-and-parcel alongside medical care. We wouldn’t be surprised to see industry leadership moving forward with an assumption that these services are a rule rather than an exception.

Read more about holistic healthcare and other market-based trends in our white paper, The Best Market Opportunities in Healthcare.