One payer hopes to make healthcare more equitable by using alternative data.
The film Minority Report imagines a world where someone’s destiny can be viewed before it occurs. Holographic, 3D maps illuminate people in bad situations—sometimes due to choice, others trapped in circumstance, often a combination.
That was a movie. But the truth is, there is a real map of probable, negative outcomes that already exists. It’s often defined by a person’s ZIP code and what it’s like to live there, marked by social determinants. If that reality was a heat map, florid-red hotspots would mark a complex interplay of too much and not enough—too much crime, poverty, and crumbling infrastructure and not enough jobs, community centers, and grocery stores.
It has been said that ZIP code is a better predictor of health than your genetic code, an early and novel way of describing the social determinants of health (SDOH) and their effect. But why do SDOH matter now more than ever before, and how are payers using them to create solutions?
The role of alternative data in SDOH
Enter alternative data, or any data external to what a company (such as a payer), collects on its own. Alternative data offers broader source, scope, and value. The financial services industry was the first to use alternative data in a significant way, with venture capital firms looking beyond traditional sources (e.g., from personal and professional networks, SEC filings, and financial statements) to make better investment decisions.
Today, alternative data usage is growing rapidly by usage and type, with a revenue forecast of $17.35 billion by 2027. Alternative data now includes nearly every sector of the global economy—from insurance, manufacturing, transportation, and retail to IT, telecommunications, media, and entertainment. And there are literally thousands of data sources and collection portals. Websites, mobile apps, sensors, and wearables collect data through direct input while cameras, drones, and satellites collect valuable data from afar. Add to this the data collection software, platforms, and equipment that record human interactions with society and its institutions: education, retail, finance, government, criminal justice, and more.
One payer's approach
Healthcare is one of those institutions, and CareFirst BlueCross BlueShield is one of a growing number of payers investing in alternative data as part of a broader investment in better health outcomes for individuals and communities. CareFirst offers medical, dental, vision, and prescription drug coverage, including Medicare Advantage and Medicaid plans, for residents of Maryland, Washington, D.C., and Northern Virginia. CareFirst hopes to make healthcare more equitable by using alternative data to design interventions that incorporate SDOH.
For CareFirst, alternative data moves the goalpost forward despite the industry’s abiding patient data, electronic health record, and analytics challenges. The plan has made a $10.5-million, multi-year commitment to "addressing the root causes of diabetes" by incorporating SDOH and multiple alternative data sources. The objective is to use SDOH data to design more tailored diabetes prevention and intervention programs that achieve better outcomes for members and inform broader community initiatives.
In an interview with the Baltimore Business Journal, President and CEO Brian D. Pieninck notes the broad implications of this approach: “CareFirst is engineering a shift in the healthcare landscape, placing greater emphasis on population health outcomes, value-based care, and addressing social determinants of health to achieve health equity by leveraging analytics that drive impact." To achieve this, the health plan is focusing on "economic climate, food insecurity, health literacy, violence exposure, housing instability, transportation barriers, and coronavirus (COVID-19) vulnerability" and well as other SDOH data.
In addition to expanding data’s role in its initiatives, CareFirst seeks to expand who participates beyond its members. The plan will partner with community organizations, local businesses, and its providers—first in Baltimore City, two wards in Washington, D.C., and Prince George’s County, Maryland with expansion planned in 2022. Outcomes will be forthcoming.
Given that ZIP codes influence health destiny, it’s fitting that another Destiny is helping to create change. Destiny-Simone Ramjohn, PhD, became CareFirst’s vice president of community health and social impact in January 2020. Dr. Ramjohn is leading the organization’s vital linkage between community engagement and philanthropic investment for measurable health improvement at the broadest possible level.
"It’s insufficient to look at social determinants of health through only an individual lens," says Ramjohn. "They touch public and population health. This understanding is part of our DNA at CareFirst. Our investments are further upstream now with dedicated staff and resources. The data is accelerated, including our partnerships around it."
The importance of partnership
Washington, D.C.–based Socially Determined is one of those partners. Founded by physician and public health advocate Dr. Trenor Williams, Socially Determined is using the following strengths to help CareFirst and other customers:
- Three robust and diverse datasets, including multiple public, commercial, and consumer sources.
- A four-pronged approach to initiative effectiveness.
- Extensive integration and workflow services to link alternative and client data (e.g., clinical and claims for payers).
- HITRUST certification for data privacy and security, permeating technical specifications and operations.
Socially Determined provides clients with federal and state data; granular business data ranging from restaurants to retail; and financial data from TransUnion that spans credit ratings, buying behaviors, asset/resource information including home, car, and property ownership. Individually and collectively, this data paints a comprehensive picture of individuals and community health in every facet of life. Socially Determined uses this data to 1) identify risk, 2) quantify opportunity, 3) prioritize geographies and interventions for best results, and 4) measure intervention return on investment (ROI).
Socially Determined does the "heavy lift" for clients to manage the needed data integration and extractable intervention intelligence. "It’s harder than you would think to leverage data in a nimble, fluid way and get all the value you can," explains Williams. "Payers have to get the day to day done, often with limited resources. We bring this kind of domain focus to be a thoughtful partner." As part of this, Socially Determined allows clients like CareFirst to use the data for multiple objectives and helps their analytics teams deploy it strategically.
Williams notes that technical integration is not as challenging as it was five years ago when he founded Socially Determined. Neither are the conversations about the necessity of SDOH data for truly better outcomes. "The turning point was COVID, its disproportionate effect on people of color, and the social protests that started with George Floyd. It made so much visible in a new way." It all helps shape what Williams calls "multifactorial" interventions, those that incorporate multiple social determinants (rather than being "single domain") and do so in a sustainable, scalable way.
Trust, providers, and healthcare's highest aim
Socially Determined and CareFirst have high praise for one another. "One of our big questions was how do we accelerate systematic data collection around SDOH," says Ramjohn. "Our partnership with Socially Determined leverage analytics that drive impact."
Williams adds, "There is a real organizational commitment from CareFirst. They are thoughtful about the process and its value for the community as a whole, not just their members. Their goal is to do this work with the community, not to the community."
It’s a matter of trust. The factors that contribute to poor SDOH are linked to the reasons why vulnerable populations don’t necessarily rush to institutions like healthcare and their representatives. CareFirst focuses on the vital role that providers play in changing the landscape.
"Providers—as well as payers and nontraditional actors like financial services, philanthropic organizations, and the government—have begun to understand how SDOH factors really do impact," notes Ramjohn.
Her CareFirst colleague Tich Changamire, MD, PhD, MBA, vice president and chief medical officer, adds: "Working with providers on cultural competency, recruiting and retaining staff who look like the community—it all contributes to health equity. It’s important to help practices incorporate screening tools and to engage our practice consultants to see what’s happening beyond the office visit. It’s a 360-degree approach."
That 360 degrees calls to mind the 3D map that opened this feature, the one where ZIP code determines outcomes. It doesn’t have to. With understanding, collaboration, and a lot of alternative data, ZIP codes can help redraw patient-first solutions—whether that patient is healthy or has cardiac disease. SDOH recognize that part of what might be wrong with a person’s heart are the things breaking it, things healthcare can help solve when it is achieving not only the Triple Aim but its highest one: respecting that patients are people first.
“It’s insufficient to look at social determinants of health through only an individual lens. They touch public and population health. This understanding is part of our DNA at CareFirst. Our investments are further upstream now with dedicated staff and resources.”
Destiny-Simone Ramjohn, vice president of community health and social impact, CareFirst
Laura Beerman is a contributing writer for HealthLeaders.
Social determinants of health (SDOH) are a powerful influence on human well-being.
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