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Analysis

5 Ways Social Determinants of Health Affect the Revenue Cycle

By Alexandra Wilson Pecci  
   December 27, 2018

From readmissions to no-shows, factors like addiction and food insecurity have an impact on billing, collections, and the bottom line.

Social determinants of health has been one of the hottest topics over the past few years, as everyone from HHS to health plans to health systems try to tackle the issue.

That's why it's notable that a new survey of consumers shows that 68% respondents said they have challenges in at least one social determinants of health (SDoH) risk category. This is also bad news for revenue cycle departments as SDoHs can affect patients' payments. 

"Addressing SDoH challenges for patients can have overwhelmingly positive effects on the patient’s health and the country’s overall healthcare system," Matthew Hawkins, CEO and board member of Waystar, tells HealthLeaders via email. 

"But, in an era of health system transformation, providers, healthcare organizations and payers still lack the tools, programs and community partnerships required to identify and address patient needs," he says.

The risk categories included in the survey, which was conducted by Waystar, include financial security, food insecurity, social isolation, housing insecurity, addiction, transportation access and health literacy.

The survey found that 25% had a “moderate risk” (elevated stress in one to two categories) and 27% were “high risk” (elevated stress in three or more categories).

Despite the prevalence of these risks, only 22% of consumers with SDoH stress have discussed these issues with their physician. Also, of all patients in the “high risk” segment, 60% have never discussed their issues with a provider or their insurance company.

We asked Hawkins to break down the survey's findings and the implications for the revenue cycle. The email conversation has been lightly edited for clarity.

HealthLeaders Media: What are some key findings from the survey as related to revenue/revenue cycle?

Matthew Hawkins: SDoH risk is present across payer classes, and no payer group is without high-risk segments.

Patients with high SDoH risk are over three times more likely to miss multiple medical appointments per year. No-shows impact patient health (missing necessary care), and financial health (missed appointments means no reimbursement and lost utilization).

SDoH risk profiles inform collection follow-up strategies and customer segmentation: For example, patients with health literacy issues may receive more simplified communication/documents than those without.

Payers and providers need to be strategic about how they bring up SDoH: Patients with SDoH issues are 2.5 times more willing to talk about those issues with clinicians compared to payers. Additionally, most of the SDoH conversations that are occurring are with patients that are least likely to have health issues and least likely to utilize available support services.

HLM: Can you please explain how social determinants of health affect the revenue cycle?

MH: SDoH issues and risk are present across all revenue classes (not just Medicare and Medicaid). No payer group is without high-risk segments.

SDoH factors can be viewed as a common thread that underlies a patient’s clinical and financial experience. No matter if a patient is talking to a doctor, nurse, financial counselor, registration clerk or billing rep, the patient’s social determinants will influence their decisions as a healthcare recipient and consumer.

There are many points of intersection between SDoH and RCM:

  1. No-shows: SDoH risk correlates to risk of appointment no-shows and can be used to inform prevention strategies. No-shows impact patient health (missing necessary care), and financial health (missed appointments means no reimbursement and lost utilization).
     
  2. Bundled payments: With multiple events in the delivery routine, risk factors at home and in the community can make it harder to adhere to the sequence (therapy, medications, follow-up appointments, dietary plans) leading to leakage in revenue and reimbursement, and poor health outcomes.
     
  3. Readmissions: Readmission management can be improved by 20% or more when the SDoH elements are integrated to the clinical routines. This means penalty reduction as well as improved health.
     
  4. SDoH risk profiles inform collection follow-up strategies and customer segmentation. For example, patients with health literacy issues may receive more simplified communication/documents than those without.
     
  5. The combination of clinical, claims, and SDoH data enables a future of consolidated follow-up calls to improve care coordination and patient experience. A single representative can follow up on outstanding balances, appointment scheduling, simple health status checks and getting the patient connected to appropriate home and community-based services.
     

HLM: Can you give any real-world examples of hospitals/health systems that have addressed social determinants of health and experienced an improvement to their bottom line?

MH: Geisinger used SDoH to sub-segment their diabetic population looking at food insecurity. They then deployed a nutrition program targeted at those individuals and saw [significant clinical and cost improvements].

In January 2018, the University of Illinois hospital invested $250,000 to extend its pilot program in partnership with the Center for Housing and Health in Chicago to provide chronically homeless patients permanent housing to improve their health and reduce their costly emergency room visits.

Results from the 2015 pilot showed that [the average monthly healthcare cost per patient dropped 18% from $5,879 per month before being placed into housing to $4,785 after being placed in housing.]

HLM: What practical actions should readers take after learning this information?

MH: Figuring out how to engage patients in their SDoH challenges is core to successful, cost-effective and high-value population health management. However, current efforts are still limited and have inefficacies, such as unevenly applied targeting, or done in a way that consumers choose to reject today.

As a first step, RCM leaders need to talk with their care teams on the front lines to close the gap they have in understanding the SDoH needs of their patients. Then they must figure out how best to gather that information at scale across their full population.

A promising solution to this is technology utilizing predictive data analysis, which can segment patient populations without manual survey efforts, enable pre-arrival preparations and suggest more appealing methods for program uptake.

This allows organizations to modify workflow to leverage these analytics in support of more accurate targeting of high risk patients, more effective methods of engagement and more efficient allocation of human and financial resources.

Alexandra Wilson Pecci is an editor for HealthLeaders.


KEY TAKEAWAYS

Use customer segmentation to identify at-risk patients.

Allow social determinants of health to inform communications strategies.

Consolidate follow-up calls to improve care coordination and patient experience.


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