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A new urgency for addressing social determinants of health

Social determinants of health have taken on new importance during the COVID-19 pandemic. Already heavily influential over health outcomes, determinants like income, housing and food insecurity as well as loneliness may be more potent now – and job losses, pay cuts and furloughs almost certainly mean they are also more widespread.

Speakers at AHIP Institute & Expo Online discussed social determinants in the COVID-19 era from a variety of angles. Takeaways include the following:

Meeting the need might not be enough:  L. Susan Zhang, director of Medicaid products at HealthFirst shared an interesting story about a conversation between a HealthFirst care manager and a member. They were discussing access to local food resources, and the member made her opinion of places packed with fruits and vegetables clearly known: She had no plans to eat the produce. “Addressing the need does not equate to transformation,” Zhang said.

It’s important to remember that the most vulnerable members’ worries go well beyond whether they get adequate nutrition, Zhang said. Their concerns are much more fundamental. “When you are so focused on survival day to day you are not thinking about thriving.” Health plans should focus foremost in supporting stability for members, Zhang said. And they must also bring persistence, complementary interventions and patience.

Stigmas are falling: Getting people to open up about SDOH has always been a tall order, but Jennifer Christian-Herman, executive director of strategic customer engagement, product innovation and evaluation at Kaiser Permanente sees signs that people are letting their guard down – and consequently are more likely to reach out for the support they need.

Social determinants belong in value-based care. “We believe social determinants should be treated as critical gaps in care,” Humana Vice President of Bold Goal and Population Health Caraline Coats said. She argues SDOH should be integrated into value-based arrangements, and so Humana is working to support screening, documentation and referrals as part of value-based arrangements, incentivizing clinicians to address social determinants, and then also giving them the tools to do so.

Employers can make a difference: Employers have an important role to play, Christian-Herman said. Long thought to fall outside their purview, social determinants play out in all kinds of ways in the workplace, affecting productivity, absenteeism and other metrics that matter to employers. The business case is not hard to make. And it turns out employers have a variety of tools to make a difference: wellness initiatives, employee assistance programs, community partnerships and corporate responsibility commitments, among others. Employees will need support more than ever, Christian-Herman said. “Employers should assume most of their employees are dealing with something when they are coming back into the workforce,” she said.

Resources can be a moving target: Health plans have focused considerably in recent years on forging connections between members and community agencies that can help address SDOH. One challenge in a pandemic is that new resources are becoming available all the time – while other organizations are closing their doors or reducing services as funds run dry. Zhang said creating a feedback loop where those changes are logged, keeping their database more accurate, makes it more effective. And the use they have made of this functionality during the pandemic underscores the important of being able to adapt quickly in a crisis.

Partnerships are powerful, and so are neighborhoods: Florida Blue Market President Tony Jenkins and Lift Orlando President Eddy Moratin provided a case study in purpose-built community development as a way of addressing health and many social determinants at once in underserved areas. “What we all need most is a caring and connected neighborhood,” Moratin said. The West Lakes community of Orlando, Fla., is an example of what can happen when an organic, local vision is supported by stakeholders who commit more than just dollars to areas plagued by inequities. The community integrates mixed income residential areas, educational programs and a multifaceted wellness center that includes not just Florida Blue’s support, but also its presence. “If you are trying to find programs, yeah, maybe all you need is dollars,” Moratin said. “If you are trying to effect change, you need leadership.”

 

Melissa Turner is director of health care and life sciences content at SmartBrief. She edits science, medical and health care delivery newsletters and oversees development of content marketing pieces for SmartBrief’s health care clients.

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