With a sea of SDoH reports, what will it take to yield change?
America’s Health Insurance Plans (AHIP) recently announced its newest initiative, Project Link. The intent of this well-aimed effort is to address those social and non-clinical issues that can’t simply be addressed by a prescription pad: the social determinants of health (SDoH). Project Link seeks to focus on client long-term health and wellness by:
- Bringing together health insurance providers from varied markets and populations; then
- Establishing collective strategies and goals for those providers that create new programs to address the SDoH, ones that are scalable, sustainable, and measurable in improving health and affordability for all; and
- Working with AHIP to develop research and policy agendas at the state and federal levels.
However, reading the project goals triggered one overriding question from me: What healthcare stakeholder hasn’t implemented the same, if not similar, goals as Project Link over the past 18 months?
A Sea of Reports
AHIP gets points for organizing a collective payer response. Membership associations such as AHIP often develop positions for their members and other industry stakeholders. Once such a position is established, the association works diligently to leverage its stance through a variety of mediums: press releases, white papers, articles in industry journals, and conference presentations, for example. They may also advocate for necessary legislation and reimbursement, plus align with other entities with common interests. Project Link is poised to be a game-changer, though it could be at risk of drowning amid a sea of other well-intentioned reports.
A quick walk down memory lane provides a recent summary of other such initiatives, all geared to establish cost-effective programming for the SDoH populations. Over the past year, we’ve been privy to:
- Medicaid Transformation Project: a national effort to transform healthcare and address social needs for the most vulnerable populations. We are one year in to this two-year effort for the engaged health systems to implement solutions that address health, behavioral health, and substance use issues plaguing underserved individuals and families across the country. Some 28 health systems are identified on the project website main page, with the usual compelling data to validate the project’s mission, primarily for the Medicaid population.
- Approximately 9 million adults have been diagnosed with mental illness; Medicaid spending for these patients is four times higher than normal.
- Tens of thousands of people die annually from heroin and painkiller overdoses; in 2009, the U.S. spent $24 billion on substance use disorder treatment, with 69 percent coming from public sources.
- Medicaid pays for over half of all U.S. births and covers approximately 25 million adult women; this population struggles with appropriate access to prenatal care, a major factor in reducing low birthweight infants.
- Health systems paid an average of 36 cents on every dollar spent for ED visits by Medicaid patients; roughly one-third of Medicaid patients visit the ED at least four times per calendar year.
However, when you click on the recent news page, the last entry is for assorted articles announcing the project launch and press release almost a year ago, Aug. 22, 2018. While a Google search for news on the project brought up a recent article on the addition of Boston Medical Center to the fold, one wonders how this the project is really moving along.
- Nationwide Interoperability Roadmap: an effort to forge interoperability with the person at the center of a system continuously improving care, public health, and science through real-time data access. The industry is five years into that 10-year plan. A Health Affairs blog post on the Roadmap had the dubious title “Are We Halfway there Yet?; Unfortunately, we are not. As discussed in my article on Medicaid Work Requirements , many persons dealing with the SDoH face limited wifi access and portal use, which could easily delay, if not derail, interoperability efforts.
- The Center for the Study of Social Policy (CSSP): A report was released titled “Social and Emotional Health through Pediatric Primary Care: A Blueprint for Leveraging Medicaid and CHIP to Finance Change.” Developed by the CSSP and Manatt Health, this report outlines five strategies for state Medicaid agencies and the Children’s Health Insurance Program (CHIP) to address adverse SDoH impacting youth:
- Cover and support a full range of screening, assessment, and treatment services for children and their parents;
- Leverage quality and performance improvement initiatives to spur changes in pediatric practice;
- Establish payment models that incentivize a focus on the social and emotional development of children, ideally as a part of high-performing pediatric medical home;
- Facilitate investment in team-based care and training on children’s social and emotional development; and
- Leverage a CHIP health services initiative to finance interviews aimed at supporting children’s social and emotional development.
A close read of this report shows detailed strategies with action steps, making it an improvement over other reports that list data without the needed strategic guidance. We all know the mantra, “a goal without a plan is just a wish!”
- Finally, eHealth Initiative’s report, “Five Ethical Ways to use Social Determinants of Health Data,” presented an organized (and, at first glance, impressive) work product with input of a robust number of over 50 industry stakeholders, including but not limited to:
- American Health Information Management Association
- Amazon Web Services
- American Cancer Society
- American College of Physicians
- Epstein, Becker, and Green
- LexisNexis Healthcare
- Mayo Clinic
- Medical Group Management Association
The report yielded five areas of focus to inform good intent. However, it presented little information that most organizations don’t already know. The areas included:
- Addressing clinical and non-clinical needs
- Using data analytics to determine patient risk
- Identifying available community resources
- Tracking health outcomes
- Involving patients and caregivers in care intervention planning
Which Plan Will Yield the Most Change?
Organizations are re-prioritizing goals and reallocating their fiscal and human capital to address the SDoH. Based on the reports summarized, the industry is demonstrating a strong commitment to collaborate toward some resolution. Between national health expenditures hitting $3.5 trillion and ongoing record numbers of health organization mergers and acquisitions, the industry has long since hit a tipping point. Which plan will yield the most change to right the healthcare ship? The URLs for each of the reports discussed are embedded in this report. The Monitor Mondays Listeners Survey from July 1 provides interesting data on which efforts have the potential to affect the greatest change.
Will these programs create sustainable changes for payers, providers, practitioners, and their targeted populations? Not if recommendations remain on PDFs only.
Survey: Which do you think will yield the greatest change in addressing the Social Determinants?
Survey Answer Options
Survey Answer Selections (%)
Which do you think will yield the greatest change in addressing the Social Determinants?
Association-based initiatives or white paper recommendations (e.g. Project Link)
Payer-based initiatives (e.g. Medicaid Transformation Project)
Payer-based reimbursement (e.g. actual reimbursement & coverage for non-clinical services by third party payers)
Legislation mandates for reimbursement & funding (e.g. as through CMS).