Payer-led Initiatives Provide Lessons in Addressing Social Determinants of Health
Health equity is a complex issue that requires complex solutions. There are no easy answers or quick fixes. It requires cross-sector partnerships among community-based organizations (CBOs), health systems, clinicians, public health departments, health information technology companies, payers, and others to create integrated health and social care networks.
In November 2023, the Biden-Harris Administration published a U.S. Playbook to Address Social Determinants of Health (SDOH) as well as several other resources, including a call to action that outlines recommended roles and actions for each partner. At the heart of these efforts is something today’s health information (HI) professionals are well-familiar with: Data.
HI professionals know it’s not easy to collect and leverage SDOH data. Data silos, lack of standardized methods for data collection, and inaccurate and incomplete data are just a few of the many challenges. However, learning how other partners such as payers collect and leverage that data can help HI professionals expand efforts within their own organizations.
Highmark, CBOs Get ‘Fuller Picture of Peoples’ Needs’
Highmark Health, a payer whose members span urban, suburban, and rural areas across Pennsylvania, West Virginia, Delaware, and New York, collects SDOH data largely from its affiliated health system, Allegheny Health Network. The payer also uses public data, member and claims data, and proprietary information to help inform its SDOH strategy.
“We have more than one million SDOH screenings on file, and for many members, we have repeated assessments on file,” says Emily Brignone, PhD, director of social determinants and research analytics at Highmark Health. “We can see whether we’re able to close gaps and get a fuller picture of peoples’ needs. We’re also able to leverage those assessments along with area-level data and machine learning to develop look-alike models that estimate the likelihood of SDOH among members who have not yet engaged with the SDOH assessment.”
Highmark Health also is increasingly turning to CBOs for data. It recently created a social care network that includes dozens of CBOs that it financially incentivizes in a value-based payment-like model for addressing social needs and closing care gaps.
“CBOs are a big part of the equation,” says Nebeyou Abede, senior vice president for SDOH at Highmark Health. “Patients may only see their provider a few times a year, but they’re out there in the community the remaining 300-plus days. The data the CBOs collect is critically important for us in terms of prioritizing care plans for our members.”
Consensus-based reporting standards will help Highmark Health take in and share SDOH data, says Brignone. “We’re in the process of getting our data into an HL7 FHIR format and loading it into Google Health Data Engine, which will make it ready for this kind of data sharing across systems,” she adds.
ICD-10 Z codes will also play an increasingly important role, says Brignone. “Providers are already really making a shift and are more cognizant of social needs and the importance of documenting and tracking them and making sure they close gaps,” she says. “More and more, providers are using Z codes even though there isn’t a full system in place to reimburse for all of these codes.”
Kaiser Permanente’s Data-based Tools
Kaiser Permanente, one of the nation’s largest not-for-profit health plans that serves more than 12.6 million members, derives much of its SDOH data from a screening tool it developed based on industry best practices.
Garett Ng, MPH, data lead for the payer, says it took time and collaboration to clearly define the process for SDOH data collection. “There are a lot of different inputs in terms of how we get information — call centers, medical assistants, clinicians, and patient self-service through our website,” says Ng, adding the goal was to create a standardized and consistent way of asking questions regardless of the setting and technology used to collect the information.
After standardization, the next step is to normalize and centralize the data, says Ng. “We want our operational leaders to be able to leverage the data,” he adds. “In partnership with our information technology (IT) group, we spend a lot of effort doing data exploration and bringing information together for reporting and tracking purposes.”
Analyzing and interpreting SDOH data correctly is also important, says Ng. “The context is really important in terms of how people analyze and interpret information,” he adds. “We want to make sure our data represents populations we treat so we can draw accurate conclusions.”
For example, in the past, Kaiser most consistently screened certain vulnerable populations. Now that it has expanded its efforts, there may be important caveats to consider when making data comparisons.
“Pre-2020, a lot of the data was drawn from the Medicare and Medicaid populations. Now we’re trying to introduce more robust — and hopefully annual — screening for all members,” says Ng. “We’re on track to screen about three million of our members. There’s a lot of people out there who haven’t been screened who may have needs. We’re trying to get ahead of that to engage them.”
Part of this engagement centers on an algorithm-based tool Kaiser’s internal research group is helping to develop. The tool, which considers SDOH, demographic, and clinical data, will ultimately help Kaiser use its data more proactively, says Ng.
Kaiser is also working on strategies to leverage SDOH at the point of care. “We want to embed [SDOH] information into the workflow, so it doesn’t burden physicians. This is where health information professionals can help. That lens and qualitative workflow perspective is critical,” says Ng.
Payers play an important role in addressing SDOH, says Abede. “As anchor institutions across many communities in the country, payers are global corporate citizens,” he says. “We have a responsibility to work with other community stakeholders to expand public and community health.”
Brignone agrees. “SDOH is a multi-sector issue, and payers can play an important role as a connector in that equation,” she adds. “We have a lot of different touch points with members of the community as well as relationships with government agencies and local benefits organizations, and we can be a hub to help connect people with the resources they need.”
Lisa A. Eramo, MA, is a freelance healthcare writer based in Cranston, RI.