The movement to better address the social and environmental factors that affect health has insurance companies and other payers looking beyond the hospital or clinic and stepping into the community to give patients help where it's needed.
That might mean giving patients free Lyft rides to the doctor's office; connecting them with a food bank or footing the bill for home-delivered meals; or financing temporary housing. Medicaid programs in some states are requiring insurers to screen beneficiaries for social and environmental factors that could lead to poor health.
While the concept of social determinants and how they affect health outcomes has been understood for years, the way some innovative health insurers and other organizations are helping patients with unmet social needs has evolved beyond isolated pilots or community benefit dollars to addressing those factors in a sustainable, scalable way.
Insurers have stepped up these efforts as they take care of broader populations and strike more value-based payment arrangements with providers. Government payers are also forming policies and implementing programs that give insurers more flexibility to address social determinants with federal funds.
“If what we are paid is based on the outcomes we are able to produce, it begins to shift the focus and realization that … we need to begin to make investments in those issues that while not traditionally healthcare-related, have such a huge impact on health,” said Dr. Richard Seidman, chief medical officer of L.A. Care Health Plan, a Medicaid managed-care plan.
Volunteers for Project Angel Food prepare medically tailored meals for the seriously ill. L.A. Care Health Plan provided a $150,000 grant for a pilot project to prove healthy meals can reduce readmissions. (L.A. Care Health Plan)
Plenty of challenges remain in figuring out how much and how best to invest to meet those social needs, but there's a growing awareness that payers that fail to appreciate the context of a patient's life will have a hard time controlling medical spending.