Recently, I had the honor of hosting the Virtual Rise Bedrock of the Social Determinants of Health Care (SDOH) event and participated in their National SDOH Conference. SDOH has been a hot topic in healthcare over the past few years, and there is good reason. The data are obvious: small health outcomes are associated with direct medical activities. Non-medical factors, the status of people’s birth, growth, life and work, often affect health outcomes and are greater than the clinical care they receive.
Connecting with SDOH experts, including health program leaders, community-based organizations (CBOs), providers, and people with life experience, has emerged some common topics that should be reflected on more deeply:
This is not always unacceptable – it is inaccessible
We need permanent retirement to the term “failed”. The root cause of finding these gaps often shows the barrier to the maze rather than being uninterested in engaging in the care required.
People don’t want to have chronic diseases or cancer. But for many people, the reality of going to a doctor for a preventive test or immunity means they missed their jobs. A lack of work, in addition to the lost wage, means that caregivers must be found for children or older spouses and secure transportation. Their health plan may provide resources to help, such as a free ride to a doctor’s visit, but they either don’t know that there is, because getting benefits is complicated and frustrating, or they have two children, and the trip only allows them to appoint one extra person. So when they don’t go, they are marked as “non-compliant”.
Instead of focusing on labels, we must use available data to identify the root causes behind care gaps (such as missing out on dates), rather than focusing on labels, and use these insights to shape the program to remove root cause barriers. I was impressed with the opening of a community center that not only provides transportation but also allows more than two passengers to provide free parenting during dates. The rides also include tablets for patients to obtain health plan resources on the go. Barriers are eliminated and community health outcomes are improving.
CMS makes it difficult for us to collect data we need to solve SDOH
During both events, we heard the challenge of collecting SDOH data (e.g., Z-codes) multiple times that the center of Medicare & Medicaid Services (CMS) did not give us enough space to enter it into the claim form. In trying to better understand and serve patients, it should not be a simple thing that barrier providers must face.
Code Z allows us to understand the basic stories and root causes that affect members’ health. Having this data and understanding this is crucial for us to drive SDOH work in meaningful ways.
If we want providers and health plans to meet the expectations of SDOH interventions, a procedure to eliminate friction is needed, rather than adding friction.
Trust and psychological safety are the basis for you to build membership
The lack of trust between healthcare systems and their consumers is well known to be due to systemic challenges of network changes, lack of expected bills, lack of access to care, and lack of customer service based on empathy sympathy. Most importantly, now incredible fears are incredible when we face daily changes in health care policies and a nation’s funding.
We heard the stories of the spokesperson who were worried that if they were to attend the doctor’s appointment, the ice would be called and they would be detained or deported, so they would avoid care at all costs. People in the LGBTQ+ community are afraid to share their personal information because they are worried about the impact. Those with drug use disorders are worried that if they share that information or seek treatment, their work and relationships can be at risk if someone finds out.
Healthcare leaders need to talk about how their organizations build psychological safety by improving business processes, communication efforts, and community support. Complaints and patient survey data are places that identify which processes or areas of the business are eroding the trust of your members/patients.
Organizations that initiate grassroots efforts by spending time in the communities they serve and asking people to share their life experiences can identify needs in their communities faster and build solutions to address those needs. If your organization is leveraging community health workers, make sure their learning and discovery has a mechanism that can attract key decision makers responsible for designing plans, benefits, and interventions.
We know that SDOH interventions are effective, so we trust the data and provide funding for the program
A large number of studies on the SDOH program have proven effective, for example, giving low-income mothers a healthy meal would have a positive impact on her pregnancy outcomes. However, we continue to be asked to demonstrate that these proven interventions will be effective and must strive to implement the funding. With the recent CMS announcements not approve future federal matching funds for designated state health plans (DSHP) and designated state investment plans (DSIPS), we face another challenge of finding innovative ways to provide plans for those who need them the most.
As health plans meet this challenge, work with your community organizations to find innovative ways to collaborate. Consider expanding partnerships, including foundations, associations and faith-based communities to fund and continue to provide critical services to your members. Continue to interact with local and state governments and advocate for policy flexibility.
The general consensus among the people I connect with in these upward activities is that we didn’t give up, but we were tired. A patient consultant and rising speaker bravely shared that during the meeting she lost her seizure benefits because she missed an unarranged date without notice. For most people, the impact on her family is incredible. But she showed up and shared her story because she knew that many people who encounter these hardships every day could not deceive themselves. This work is difficult and we don’t have all the answers. But as we enter this career in healthcare to serve others, those who need it the most, we will keep moving forward.
Photo: GMAST3R, Getty Images
Kristin Haluch of MHA is Managing Director of Innsena, a healthcare-focused listed consulting firm. She has led Medicare, Medicaid and Business Health Program initiatives and has worked with ACOS, Fortune 500 and startups. Kristin serves on the board of hungry in the United States, a nonprofit dedicated to food insecurity and health equity. Her past leadership positions include positions at Optum Health, where she led the Southern California ACO program, which generated more than $14 million in shared savings over two years. She also contributed to Walmart’s Center for Excellence and led the National Network Extension and a Phone at Spreemo Health. She received her MHA from Ohio State University.
This article passed Mixed Influencer Programs. Anyone can post opinions on MedCity News’ healthcare business and innovation through MedCity Remacence. Click here to learn how.
