In the early 1900s, health epidemics ranging from cholera to typhoid plagued America’s increasingly crowded and polluted cities. Public health services emerged during this time to manage the onslaught of these virulent infections.
Early countermeasures focused on “outside sources” of disease, including quarantining afflicted (usually immigrant) communities and rejecting diseased newcomers at Ellis Island. Ultimately, however, more effective interventions addressed root causes in public health.
In a wave of modernization, governments funded public infrastructure projects for clean drinking water and better sewer systems. Cities began regular garbage removal and insect spraying. Health inspectors ensured hygiene standards at workplaces and crowded apartment buildings. The FDA, founded in 1906, reinforced the importance of child nutrition and nurturing through public education campaigns.
These progressive measures focused on important living and environmental conditions – now called social determinants of health (SDoH). They helped reduce the virulence of disease while also improving life quality, expanding education, lowering infant mortality and raising life expectancy.
In this century, America once again finds itself confronting a dire need for better public health services. Total health spending represents over 18% of GDP even as chronic disease rates increase and health status metrics lag those of other advanced economies.
Relative to its peers, the U.S. spends less on social care. Social barriers to health among disadvantaged populations and communities underlie America’s dismal health statistics.
COVID-19’s disproportionate impact on vulnerable populations has made the nation’s social disparities even more apparent. Social determinants such as economic status, transportation, access to basic care services, housing and food security, health literacy and age, race and chronic illness have accelerated COVID-19’s spread and lethality.
A potential positive outcome from this crisis is the opportunity to systematically address SDoH at national scale. Numerous organizations are already applying innovative and cost-effective SDoH solutions. The challenge is to coordinate and scale their efforts and maximize their impact. This will require the removal of major barriers to better healthcare services, including changing the way we value and pay for care.
Although numerous innovative organizations are addressing SDoH, they typically offer point solutions for specific social barriers. Real progress in addressing social care needs requires coordinating these types of point solutions. Large providers and payers are well-positioned to assemble and operate these services within cohesive care delivery platforms that exhibit the following features:
- Better data collection and analytics to understand member populations and target communities and individuals, improve patient identification and tracking
- Adoption of predictive models that address care needs and gaps
- Deeper engagement with members / patients to understand and address holistic needs, improve adherence, and drive healthy behaviors and lifestyles
- Broader integration in the larger social support infrastructure while filling gaps where necessary
- Investment in business capabilities and processes that enhance information sharing, improve workflow, reduce administrative burden and facilitate collaboration between partners in shared-risk arrangements
To demonstrate their value, SDoH solutions will need to deliver positive investment returns over time. Cost savings and improved health outcomes will help gain executive and policymaker buy-in to devote more resources and utilize SDoH solutions more broadly.
Targeted investments in care management models generate savings over 3-5-year horizons. Payment models must accommodate these longer return horizons for care management programs to succeed.
Developing effective ROI metrics is difficult but not impossible. For example, IU Health has developed the Healthcare Economic Efficiency Ratio (HEERO), which gauges actual spending on patient care against expected spending on patient care based on claims data for patients attributed to Medicare Advantage health plans or a Medicare accountable care organization.
As the COVID-19 storm intensifies, SDoH solutions that decrease overall care costs and improve health outcomes are imperative. A keen understanding of local markets is critical in selecting the right solutions. Yet, the best solutions will also be scalable across many communities and populations.
America won’t change the way it delivers care until it changes the way it pays for care. When payment and desired outcomes align, the potential for cost savings and improvement in health metrics drive investment in innovation and holistic services across the industry.
