A data analytics capability added this year helps the payer target health plan members for social needs support.
UnitedHealthcare has added a data analytics capability to the payer's social determinants of health efforts.
Social determinants of health factors such as food security and housing play a pivotal role in the health of individuals and populations. A landmark 2016 study published by the American Journal of Preventive Medicine found that socioeconomic factors, health behaviors, and the physical environment account for determining more than 80% of health outcomes, with clinical care accounting for only 16% of health outcomes.
Minnetonka, Minnesota-based UnitedHealthcare has been working to address social determinants of health for two decades, and the payer's new data analytics capability is bolstering the effort, says Chief Consumer Officer, Rebecca Madsen, MBA. "We have had a longstanding focus on social determinants of health. Since 2000, we have contributed more than $1 billion to 4,600 communities for such things as housing and access to care. We have been at this for a long time, but this capability became more robust in the second quarter of this year with the addition of a data analytics program."
Focusing on social determinants of health is a priority at UnitedHealthcare, she says. "Our mission is to help members lead healthier lives. Today and historically, we know that social determinants are a substantial part of overall health. In our mission to help members lead healthier lives, we want to make sure that we are not only looking at the clinical aspect but also the entire individual. We want to enhance their experience—providing them with the support that they need as well as being a true partner and advocate."
The payer has a three-pronged approach to addressing social determinants of health, Madsen says.
1. Data analytics: "We worked with the American Medical Association to develop 23 new ICD-10 codes. These ICD-10 codes more precisely diagnose social determinants of health. So, if you are in a doctor's office and they see that you have needs such as food security or housing, that can be flagged with an ICD-10 code. We pull together claims data and use predictive analytics focused on these ICD-10 codes to proactively identify on both the individual and community level who is most likely to need support. By leveraging this data, we can generate a health risk score that leads to a next-best action that is put into a dashboard. That dashboard is personalized and ranked by value, so we can use the data to have more informed conversations with an individual when we have interactions with them," she says.
2. Active listening: "We specifically train our advocates to encourage them to listen to what the health plan member says. We call them 'trigger words.' For example, if someone calls in to our advocate call center for a provider search, and they say, 'I'm hungry. I'm having trouble making ends meet,' the advocate is then aware that there may be a social determinant of health need," she says.
3. Social needs questionnaire: "The third approach is a questionnaire that we equip our advocates with to ensure that they are asking the right questions to identify social determinants of health needs," she says.
Health plan member engagement
UnitedHealthcare's call center advocates are on the frontline of the payer's social determinants of health efforts, Madsen says.
"We have a very robust dashboard for our advocates. We put a ton of information there—everything from clinical programs for health plan members, to the member's preferred name, to whether a prior authorization has been submitted and where it is in the process. We then put this information in a format that is easily accessible for the advocates. The predictive analytics model then creates a next-best action in the dashboard that the advocate can see. By having a greater understanding of the member, it enables the advocates to have a sensitive conversation with an individual," she says.
Call center advocates receive training that prepares them to have conversations with health plan members about social determinants of health, Madsen says. "The advocates are trained thoroughly in what we call 'compassion training.' We know how important it is for an advocate to have a human connection and be able to demonstrate empathy. We hire for those characteristics, and we train people in those characteristics."
Connecting health plan members with social services
UnitedHealthcare has developed a curated database to connect members with social services, Madsen says.
"If someone has food insecurity, or isolation, or financial stress, we can look in the curated database and plug a health plan member into low- or no-cost community-based resources. This database has more than 500,000 community resources across the country. For example, if a member says they are housing insecure, our advocates can then pull up an agency or community-based organization that can support that individual," she says.
Measuring the impact and return on investment
The primary metric for UnitedHealthcare's social determinants of health work and its return on investment is how many members accept offers of social support, Madsen says.
"The goal here is to support our consumers and to make sure that we are giving them the care and support that they need. This was not necessarily started to generate a return on investment because it is the right thing to do. But we have seen that 50% of the people we offer support to accept the offer. So, in the long run, we believe that this work will lead to lower medical costs," she says.
UnitedHealthcare's social determinants of health work has an impact on total cost of care, Madsen says. "When we look at total cost of care, we do that holistically and the social determinants of health work is one part of that effort. It is not linear—we cannot say that this program ties to an exact dollar amount. We want to make sure that we are doing the right thing; but when we look at total cost of care, our social determinants of health work is evaluated as part of total cost of care."
Christopher Cheney is the senior clinical care editor at HealthLeaders.
Social determinants of health play a decisive role in the health and wellbeing of individuals.
UnitedHealthcare uses claims information and data analytics to target health plan members who have social determinants of health needs.
A key metric to measure the impact of the payer's social determinants of health efforts is the percentage of health plan members who accept offers of support.