Social Determinants of Health: The Impact on Members, Health Outcomes and the Bottom Line

Social Determinants of Health (SDoH) — the social and economic conditions that can impact health outcomes — are gaining recognition as a principal factor in the effort to improve patient care. Recent studies estimate that social determinants such as availability of basic resources, income level, access to transportation and overall knowledge of the healthcare system can be responsible for up to 80 percent of a health outcome. 

While the impact of SDoH on patient health has been well acknowledged by healthcare professionals, there remains a discrepancy between recognition and responsibility. Trends toward value-based care and the idea of treating the person rather than the condition are redefining the landscape, requiring all stakeholders to work together to address SDoH and improve health outcomes on a large scale. 

Data- and technology-driven member engagement strategies have emerged as a means of identifying SDoH and connecting high-risk individuals and communities with critical healthcare resources. Here’s how analytics, engagement and care management tools are helping payers and providers overcome the socioeconomic issues affecting member health.
 

Gathering actionable data on specific factors that may be impeding access to quality care is paramount to the identification and intervention of SDoH across member populations. Drawing from a variety of sources such as census, claims and enrollment data, patient self-reporting and engagement technologies, payers and providers can begin to draw correlations between socioeconomic conditions and health outcomes. Predictive analytics and artificial intelligence (AI) tools can be used to make projections around SDoH, allowing payers to proactively address barriers to care at both the individual and community scale.
 

The entire care management lifecycle centers on member engagement, from identifying a potential socioeconomic issue to furnishing the resources to effectively address it. Leveraging data and analytics, healthcare payers can tailor their communications to reach members at the right time, through their preferred channels. This level of personalized support presents an unprecedented opportunity to intervene at a pivotal stage of care, connecting members with vital resources such as career support, transportation assistance, local food bank information and behavioral health services.
 

Overcoming SDoH must be a continuous effort that persists far beyond the initial point of contact. Integrated analytics, engagement and care management solutions allow payers to provide ongoing support, while also gauging the effectiveness of their communications in encouraging members to take action. Verifying patient self-reported SDoH factors, sending appointment reminders and providing additional resources to fill remaining gaps in care are just a few ways healthcare payers can leverage what they know about their members to help them lead healthier lives. 
 

Overcoming SDoH requires integration across the healthcare industry — from payers and providers to community service organizations and government agencies. Improved coordination of care is the first step toward large-scale reform, but this cannot begin without a comprehensive solution that addresses the full spectrum of healthcare challenges — and the varying needs of high-risk members.
 

Population health solutions like HMS Total Population Management (TPM) are helping the healthcare community better align their efforts to reduce costs, improve health outcomes and enhance the overall member experience. The TPM suite delivers actionable insight into SDoH, which payers can use to anticipate, identify and prevent the socioeconomic conditions inhibiting members’ access to care. 

For more information on the impact of SDoH and its impact on members, health outcomes and the bottom line, visit Health Ideas and join in the conversation. 
 

HMS advances the healthcare system by helping payers reduce costs and improve health outcomes. Through our industry-leading technology, analytics and engagement solutions, we save billions of dollars annually while helping health plan members lead healthier lives. Visit us at www.hms.com or follow us on Twitter at @HMSHealthcare.