Catalyst for Payment Reform

How Sidewalks Can Affect Your Health Care Costs

How Sidewalks Can Affect Your Health Care Costs

Our neighborhoods, houses, schools, jobs, income, social lives, modes of transportation, and even our broader built and natural environments. Once these were not considered factors affecting health, but they are now the focal points of a fast-growing field referred to as social determinants of health, or SDOH.

To begin to move beyond the idea that ‘health’ equals ‘health care’ and get comfortable with this expanded understanding of how to promote better health outcomes, let’s imagine a few scenarios. Income level: How can a registered dietician at a hospital expect their diabetic patient to follow through on a nutrition plan when the patient is struggling to make ends meet? Home life: Does knowing that a child’s home has mold problems impact what a health care provider would consider to be the most effective way to prevent an asthma exacerbation? Social context: Does living in a society with a prevailing stigma about mental health prevent individuals from seeking care that would greatly benefit them?

While SDOH makes sense, it can also seem overwhelming to employers. Once you begin to imagine all the factors that can affect a person’s health and their health outcomes, it can be like spiraling down the rabbit hole and into Pandora’s box. Employers may struggle to define the scope of SDOH as they look to address these issues. Others may be wary of making an investment designed to address the environmental factors impacting health in an unseen and hard to measure way.

The best place to start is by looking at your data and trying to identify red flags that may indicate that a problem is occurring in your covered population that could be addressed through an innovative SDOH approach. For example, is a lack of transportation keeping dialysis patients from attending their appointments? Is there a spike in emergency room visits during hot weather that could be addressed by connecting employees with ventilation equipment for their homes? Is significant out-of-network spending at mental health providers suggesting that you need to evaluate the mental health options available to employees?

In order to keep up with the growing movement of recognizing the role of SDOH in health benefits, employers will need to abandon a “one-size-fits-all” mentality and think through specific strategies to meet the social and environmental needs of defined segments of their population. According to NBGH’s Large Employers’ 2018 Health Care Strategy and Plan Design Survey, more than one third of large employers use wage-based premium contributions to increase health care access for employees with lower wages.

Whatever path you decide to go down, it’s important to remember that the original intent of the social determinants of health movement was to show that it’s necessary to think bigger. Large employers have the opportunity to promote population health at the community level; in fact, many of them already do – or once did. By contributing to cross-cutting public health activities like participating in a community health assessment, employers can strengthen the comprehensiveness of the local population health system, which researchers have found to be correlated with a reduction in socio-economic disparities in health outcomes. In order to get back to pre-2008 levels of employer-community engagement for population health, employers can once again step up to the plate by connecting with local public health officials and finding areas for collaboration.

Are you ready to embrace the idea that health is something more than what employees get at their doctor’s offices? Is your organization interested in supporting strategies that recognize that health begins – long before illness strikes – in our homes, schools, and jobs?

Here are the top three resources to support you in this journey:

  • CPR’s Fall 2018 webinar: Watch the webinar recording with Discern Health’s Guy D’Andrea, and AirCraft GearCorp’s Jim Knutson to understand which quality measures serve as proxies to track social determinants of health in your interest population. Use this understand how to analyze your data and incorporate a SDOH strategy into a payment reform arrangement, including information on the vital role of risk adjustment.
  • Social Interventions Research & Evaluations Network (SIREN): UCSF’s SIREN provides an evidence database where you can filter results across 18 different social determinants of health focus areas, including Food/Hunger; Transportation; Childcare; and Housing Quality, among others! This is the one-stop shop to find the latest research in social interventions for improving health care quality.
  • Robert Wood Johnson Foundation’s A New Way to Talk about Social Determinants of Health: Built from research conducted by Olson Zaltman Associates and Public Opinion Strategies, this guide helps you understand why some messaging is more successful than others toward getting your colleagues on board with your goals. Use this guide to develop your communications strategy to support your efforts.

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