How to Create an Equity Measure in 5 Steps

Healthcare leaders must manage health equity measures as part of strategy and profit and loss.

How do you make a metric that matters?

Measure twice, cut once.

It turns out that the home repair adage also applies to…well, measures. This includes the health equity measures that a growing number of healthcare leaders must manage as part of both strategy and profit & loss (P&L).

Measuring a health equity metric twice means assessing and reassessing whether it is worth developing, no matter how compelling the subject. Once that decision is made, cutting once means delivering a well-designed measure that delivers value quickly. Over time, metrics must also be optimized as everyone learns more about what they reveal.

Trenor Williams—founder and CEO of Socially Determined—detailed for HealthLeaders in five steps how to create effective measures for social determinants of health (SDOH) that improve health outcomes and business performance. Socially Determined's newest metric is Social Connectedness.

Step 1: Ruminate

"Social connectedness has been on our radar since 2016. But what's important with developing any metric is the ability to get consistent quality data," says Williams.

Socially Determined conceptualized the Social Connectedness metric for several years before developing and refining a model that would work for every healthcare sector, including the P&L leaders who must deliver profits that don't leave people behind.

"Net new data sources, COVID-19's impacts, and several years that highlighted the lack and importance of social factors—these factors plus market pressure and interest allowed us to prioritize."

Step 2: Make sure you have the data

In developing Social Connectedness and other equity metrics, Williams stressed the need for data that can assess both individual and community risk.

"Our model is to have individual data sources that consistently feed the algorithms for reliable, thoughtful insights," says Williams.

To deliver value, health equity intelligence should include geospatial, migration, and other open-source and proprietary datasets. Rich sets are those that can be collected consistently and across the entire country.

Step 3: Determine whether the metric achieves something

Data needs to do something, especially in healthcare. And metrics—aided by advanced analytics—exist to not only measure outcomes but improve them. Applying social risk analytics to SDOH data helps organizations understand what Williams calls the "contours" of need. The result is tailored solutions that are more likely to meet community, organizational, and systemic goals while not leaving people behind.

"You have to think of metrics in a longitudinal way," says Williams. "Upstream is only half the story. Data frequency and validity are critical, too."

Giving healthcare decision-makers the ability to act on data is why some equity metrics may not make sense. Crime and violence are one example.

"This data has a real impact on the social determinants of health," says Williams. "But crime data is not consistently reported, which impacts the ability to use it to assess risk and deal with gaps."

Williams adds that the best metrics give organizations the "action arm" to respond to elevated risk.

Step 4: Ask if it can solve more than one problem

The best health equity metrics navigate multiple needs.

For his company's Social Connectedness metric, Williams notes the need to design targeted interventions at the personal level that also inform broader strategic goals: "You have to think about where the dollars, the partnerships, and the organizations are."

The example he gives is how the observations of a health plan's case managers can help direct supplemental benefits to meet individual and market need.

Strong metrics and social risk analysis straddle personalized medicine and population health, just as payers and providers do.

Step 5: Don't stop improving and don't hand over the keys

Even the best-designed metric needs adjustment. "Our job is to optimize and continually enhance SDOH metrics to deliver more value to the organizations we partner with."

On the payer side, those organizations include CareFirst Blue Cross Blue Shield; Aetna—whose Medicaid team is "investing heavily" in social determinants, according to Williams; and the fast-growing Priority Health, the Michigan health plan that is part of Spectrum Health, a leading regional IDN.

"We believe in long-term sustainable relationships and have a disciplined process. We're not just handing over the data. We're spending a lot of time with our partners—how they act, who they're supporting," says Williams. "This gives us a consistent view," a value for optimizing metrics and assessing social risk long term.

Finding the balance with health equity ROI

The last two years have exacerbated social isolation, loneliness, depression, and anxiety.

Williams—a former family physician and the son of a social worker—agrees, adding:

"At the end of the day, what I get most excited about is the impact that changes people's lives. ROI isn't just about avoidable utilization and preventable cost."

Simultaneously, there isn't a single healthcare decision-maker who isn't thinking about how to link SDOH to traditional ROI. The pandemic wouldn't be revealing long-standing disparities if addressing them wasn't already ingrained in the deepest levels of business strategy and prioritized at scale.

In healthcare, suffering is both a human problem and a business one—with well-designed metrics critical for addressing both.

Photo credit: This image of Baltimore City, Maryland, Socially Determined’s SocialScape platform processes dozens of elements, including geospatial data from SafeGraph, migration data from the IRS, and other open-source and proprietary datasets, to identify populations. Photo courtesy of Socially Determined.