While the importance of addressing social determinants of health (SDOH) is now a common theme in reputable conferences, learnings are growing richer and more intense. In June, The West Coast Payer and Provider Summit to Address Social Determinants of Health for Complex Populations was an industry gem hosted in Scottsdale, AZ. Here is a recap of what I felt were some of the biggest takeaways from the summit.
1. Purpose Driven Change-Leadership Workshop by David Shore, PhD, Harvard
Throughout the summit weekend, many workshops were presented by thought-leaders in the space. David Shore’s workshop was a veritable delight of new twists on old themes to jog the mind and start a new race for transformative change within one’s sphere of control. Some key points included:
- Spending extra time shaping questions to ask increases the efficiency at arriving at solutions
- Project life cycles should be front-end loaded with interrogations of reality and refuting assumptions
- Conduct a sequence of smaller projects that feed into a cohesive program instead of long drawn out projects
- It’s only innovation if you effectively solve meaningful problems, which you can scale and spread
- Sustain with the “Science of Spread” methodology
- According to research, the optimal size of a project team is seven to eight people – if it takes more than two pizzas to feed your team lunch, you have too many people!
- Many interesting points of view of healthcare providers regarding SDOH
- While 40-50% see their important influence on outcomes, 70-90 % don’t necessarily think it’s their job to respond to those needs.
- A personal favorite: go beyond lessons learned to lessons leveraged!
2. Extensions of the Triple Aim Statement Reframing the Importance of SDOH
First, we had the Triple Aim, then quadruple and now… the quintuple aim:
- Cost
- Quality
- Patient Experience
- Provider experience
- EquitySDOH
As this Triple Aim Statement continues to expand, what do you envision to be the sixth?
3. Social and Healthcare Platforms
Early stage entrants working on cloud platforms to connect care, patient created and social data are seeing encouraging early gains. Below are some notable platforms to keep an eye out for:
The Real-World Education Detection and Intervention (REDI) Platform:
- Currently deploying in border towns along southwest Texas by UT Austin Lynda Chin, MD’s team in collaboration with PWC (pro bono), AWS, and Walmart
- They report a 1.7% decrease in Hgb A1 c of diabetics in an integrated data sharing program with remote monitoring
ORCHWA Platform:
- An Oregon 1115 Waiver project is driving to get large numbers of community health workers across the state to document on and create closed-loop referral
- They focused more on the human aspects of this and it seems that they may still be in technology development
4. Powerful Visualizations for Action
This was a “blow you away presentation” with some truly powerfully meaningful novel approaches driven by Jason Cunningham, MD, CMO of West County Health Centers. Below are suggested steps one can take to innovate the virtual world of healthcare:
- Use a mix of vendors to include Tableu, Unifi + KUMO + Argis
- Create visualizations for actions. For example, zip code areas affected by wildfires were targeted and cross referenced with their patient list allowing the ability pinpoint their patients for proactive outreach
- Allow for early identification and replacement of lost belongings including medications, medical supplies, and strong patient experience feedback approval
5. Early findings and Interesting Metrics to Prove the Value of SDOH Intervention
While the consensus opinion and extensive research clearly indicate the magnitude and causal nature of SDOH’s influence on health outcomes, quality, and cost, most interventions depend on unique funding streams. This is because ROI hasn’t been proven to hit mainstream reimbursement. Examples include:
- WellCare Insurance Plan reported a decrease of $2,400 per year per member for those who received social needs interventions versus those who did not
- Sutter Health used a Health Equity Index to target risk populations affected by disparities and used the index to prove intervention effects
- Kaiser Permanente created a patient “feelings of hope” scale
- Special Needs Plans (SNP) used a “Loneliness scale,” which contributed to disease progression and longevity to target and monitor at-risk individuals
Return on investment is largely focused on health outcomes, but how can we measure the social outcomes of Social ROI?
6. Speeding Up Patient Transport
Getting patients where they need to go, when they need to go is a top priority that has an impact on not only outcomes but patient experience in terms of ease and convenience. Just think about your own stress when your car is in the shop, stress can agitate any clinical state. Interesting approaches to speeding up patient transport include:
- Ordering patient transport through referrals in their EHR
- Superimposing public transport routes onto patient location density and using the information to advocate for new routes
7. New Term – “Patient Disengagement”
Patient engagement often is a “catch-all” bundled term. But new ways of disentangling the terms unlocks possibilities, such as:
- Disengagement Vulnerabilities- a method of enumerating characteristics of individuals and their circumstances that can interfere with engagement to target and develop personal connectedness
- Tangible incentives are used to increase participation and encourage healthy choices
8. Payer Pressing Mobile Engagement for the Homeless Who Are “Not Ready to be Housed”
“Housing first” advocates began changing the landscape and the dialogue on the all-too-common reality of homelessness. One size doesn’t fit all in this multidimensional problem. A notable example is the homeless and housing resource team created by ANTHEM Indiana Medicaid. If patients aren’t ready to be confined by walls, the program provides a cell phone and a mobile app to engage them with online tools.
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