Opportunities for Payers to Address SDOH

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In our last blog we discussed how providers can specifically address the social determinants of health (SDOH) in their day-to-day operations. For individuals to receive the comprehensive and holistic care they deserve; providers and payers need to work together to treat the immediate condition, as well as other factors to improve overall patient care. If SDOH is embraced and embodied we are not just treating one symptom, rather the whole person and therefore truly focusing on the influence these factors have, which can lead to improved health outcomes.   

The health care system is constantly facing the challenges of working in silos, which creates issues around communication and interoperability between payers and providers. Given this dynamic, information around an individual’s SDOH factors are not always passed from one system to another, potentially getting lost in the shuffle. By working more collaboratively with providers, payers will have the ability to help influence and address the social factors that influence health outcomes and reduce costs for their organizations.   

Payers and providers have differing relationships with the individuals they serve, but there are more and more examples of both groups working together to improve health outcomes through unifying programs. Below are some examples where payer-initiated programs improved work with providers and thus influences overall SDOH factors and health outcomes:  

  • Kaiser Permanente is advancing a “Total Health” framework to address the SDOH in neighborhood school settings that focus on health-promoting policy, system, and environmental changes. To accomplish this, Kaiser Permanente is screening patients for unmet social needs to refer them to relevant resources in their communities. Data has shown that 78% of those screened have one or more unmet social needs.  
  • Molina Healthcare opened a resource center for homeless members to avoid emergency department use for nonmedical needs. They also purchased two behavioral health subsidiaries to focus on SDOH and launched a clinical setting to screen patients for nonmedical social needs.  
  • CareSource launched a pilot program in three states to help members get and keep jobs that can improve their lives. Among other activities, the program addressed education and skill haps and links members with employer partners and life coaches.  

If payers and providers assess individuals in a more holistic way, it will make a huge difference in the health and wellbeing of those served. SDOH are becoming just as important as medical record information, and with on-going effort and partnerships, we will continue to learn how these factors influence overall health and wellness of individuals in our communities.  

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