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Health Plan Addresses Social Issues With Data

Analysis  |  By Gregory A. Freeman  
   May 30, 2018

Social determinants of health could have more influence on a person's outcome than the actual care received. Addressing those factors is increasingly important for insurers.

Real progress on addressing social determinants of health (SDOH) to improve outcomes and quality of care within a health plan population could depend on gathering SDOH data and making it accessible to the frontline provider.

For years, health plans have been talking about SDOH­­—socioeconomic and societal issues that can affect people's health and impede proper healthcare delivery­—but finding a way to apply it and gain some practical benefit for both the insurer and the customer has been challenging, says Gabriel Medley, vice president of quality and risk adjustment programs at Gateway Health.

Gateway Health provides Medicaid services to about 500,000 people in Pennsylvania, Delaware, and West Virginia, and Medicare coverage in Pennsylvania, Kentucky, Ohio, and North Carolina.

SDOH data will become increasingly important to health plans as they develop ways to collect better information on SDOH and put it to use, Medley says.

Gateway Health is making headway using data to gain better insight into their population’s socioeconomic barriers to care. The approach can support members who might have otherwise fallen through the cracks if SDOH were not captured, Medley says.

"The future is a data game. The health plans that are able to keep up with the member with dynamic, current, useful information in a cost-effective, real-time way are the ones that will be at the forefront of improving quality for the member," Medley says.

"We have to nest that SDOH data with claims experience and all other different buckets of data flowing to create a common picture in a risk stratification model, then place that information wherever that member is getting care," he says.

Doctors Want SDOH

Providers are looking for SDOH data because they are tired of hearing that they are not meeting quality measures, Medley says. They realize that there are SDOH factors that affect their efforts to provide quality care, so they want to incorporate that information, he says. Such factors can account for more variance in health.

"There is a lot of information available to providers in the chart, but not all of it is provided in a way that makes it actionable in a timely fashion, and some SDOH issues are not reflected in a typical patient's medical record," he says.

"That's where the healthcare sector is going: How do you get this data in a fast, cost-effective manner, and how do you get the data aggregated and organized in a way that the provider, care manager, pharmacist, or even the call center can use it?"


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Gregory A. Freeman is a contributing writer for HealthLeaders.

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