Better Care Management, Lower Costs

The shift to value-based care is causing providers to rethink their approaches and seek innovative solutions to improve care and lower costs. New performance incentive programs and regulations tied to quality outcomes such as MACRA are further pressuring them to make changes that help with proactive outreach and care management to make sure their patients get well and stay healthy and out of the hospital. One of the most promising areas for achieving that goal is social determinants of health data. 
 

Predicting future health risks has always posed a challenge. Hospitals have traditionally used medical and pharmacy claims data as their main source of information, but that data doesn’t give a complete picture of the patient. 

In fact, studies show that medical determinants only account for 20% of healthcare outcomes, whereas social determinants of health account for as much as 50%¹. These conditions impact their likelihood to develop health issues as well as their ability to effectively manage those conditions. 
 

Clinically-validated information on social determinants of health can be extracted from public records and, through the use of advanced analytics, provide important information that could affect future health outcomes as well as point to correlations in drivers in care such as food insecurity or lack of transportation. 

This data gives providers a well-rounded view of a person’s lifestyle, environment, situation and behaviors. It looks at questions such as: Does the patient live in a food desert? Is it a high-crime neighborhood? Are they socially isolated? Is their income low? The answers have a significant impact on the patient’s health, risk for readmissions and access to care. 
 

The insights that can be gleaned from socioeconomic data are only valuable if they prompt action. The direction in which healthcare is headed points to using social determinants of health to:

• Focus on prevention by identifying risk factors in patients
• Have a more holistic picture of patients to drive treatment decisions
• Increase engagement by interacting with patients on an ongoing basis
• Decrease treatment costs by proactively handling health issues
• Reduce hospital readmissions by anticipating challenges a patient may face in recovery

To ensure success under value-based payment models, health systems must look beyond clinical data. Social determinants of health data could be a game changer. It doesn’t replace medical data. Instead it serves as a supplemental data source to paint a clearer picture to enable sound care management.  

With better insights into the whole picture of a patient, providers can allocate resources more effectively. They can be proactive in connecting patients with social services and can do more to encourage patients to make healthy lifestyle choices. In essence, they can provide support in a variety of impactful ways—all with the goal of keeping patients healthy, improving outcomes and reducing costs. 

To learn more, download our ebook, How ACOs Can Harness the Power of Social Determinants of Health, call 866.396.7703 or visit risk.lexisnexis.com/healthcare.