Social Determinants of Health and The Role of Virtual Care
Increasing costs of healthcare and prevalence of chronic diseases are motivating payers to improve the health of member populations while managing the resources involved. In order to impact overall health, payers are recognizing the need to address the social determinants of health (SDOH).
SDOH are the factors that affect health outside of the four walls of a traditional healthcare setting (e.g., hospital, medical office, etc.). As Humana Foundation Interim Executive Director Pattie Dale Tye stated in HealthPayerIntelligence, “Health doesn’t happen in the doctor’s office. Health happens in the community and at home.”
Healthy People 2020 developed a “place-based” organizing framework related to SDOH. The framework’s key areas (determinants) include:
- Economic Stability: Employment; Food Insecurity; Housing Instability; Poverty
- Education: Early Childhood Education and Development; Enrollment in Higher Education; High School Graduation; Language and Literacy
- Social and Community Context: Civic Participation; Discrimination; Incarceration; Social Cohesion
- Health and Health Care: Access to Health Care; Access to Primary Care; Health Literacy
- Neighborhood and Built Environment: Access to Foods that Support Healthy Eating Patterns; Crime and Violence; Environmental Conditions; Quality of Housing
The Kaiser Family Foundation highlights that health and well being are affected by factors such as genetics (30%), individual behaviors (40%), social and environmental factors (20%) and access to health care (10%). Excluding the role of genetics, the other factors combined can influence 70% of an individual’s ability to avoid the risk of premature death.
The SDOH influence an individual’s ability to understand the importance of healthcare and is connected to an individual’s access to care and ability to enhance one’s health. Payers increasingly need to address members’ SDOH-related needs outside of traditional healthcare settings in order to keep members healthy, and more importantly, at home vs. in the hospital.
Payers can use the SDOH to determine which members need better access to overall care (not just medical) and leverage a virtual care platform to understand and address members’ individual situations. By conducting virtual visits with members who are most at risk for readmission, payers’ care management teams can better care for members. Care team members can engage members in their treatment plan on a more convenient and more frequent basis by not requiring members to secure transportation to follow-up medical appointments. Time and travel related expenses can be minimized and appointment no-shows can be reduced. With virtual visits, care team members can understand the realities of the members’ home environment and their available resources (financial, food, social, etc.). By using a virtual platform, care team members can see the members’ day-to-day lifestyle and individualize the care (and conversation) to the members’ unique situation. Virtual visits, conducted from the member’s own home, also address any personal barriers to receiving care or participating in in-person visits. This is especially critical for members with mental / behavioral health conditions who may fear stigma in receiving treatment at known behavioral health care settings or for members who may hesitate to allow in-home appointments
Many member populations may experience feeling a disconnect to healthcare due to their SDOH. Virtual care is just one way which can help members access care in a timely and convenient manner and adhere to one’s treatment plan. For these members, virtual visits can help members access the care they need, when they need it.
This article was originally published on the Synzi Blog and is republished here with permission.