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Medicaid

Addressing Social Determinants of Health (SDoH) through Medicaid

By July 24th, 2023No Comments

Affecting a broad range of health and quality-of-life outcomes, socioeconomic, and environmental factors constitute what is known as Social Determinants of Health (SDoH). These factors can be used to create social and physical environments that promote good health.

To achieve better outcomes, states and managed care organizations (MCO) must first understand what determines and impacts their members’ health. These stakeholders must be able to “assess risk, identify trends, stratify member risk, and proactively intervene.” To this notion, there is a clear demand for predictive accuracy of risk associated with healthcare and related costs.

Understanding Social Determinants of Health

As we’ve examined, Social Determinants of Health are conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. In fact, medical care determines only 20% of overall health – while social, economic, and environmental factors determine 50% of overall health. According to Health People 2020, “nearly everyone is impacted by SDoH in one way or another,” and recognizes 5 key domains:

  1. Economic stability –e. poverty; employment; food insecurity; and housing instability.
  2. Education –e. high school graduation; enrollment in higher education; language and literacy; early childhood education and development.
  3. Health and healthcare – Access to health care; access to primary care; and health literacy.
  4. Neighborhood and built environment – Access to foods that support healthy eating patterns; quality of housing; crime and violence; and environmental conditions.
  5. Social and community context – Social cohesion; civic participation; discrimination; incarceration.

Earlier this week, Softheon CEO, Eugene Sayan, and Welltok CEO, Jeffrey H. Margolis spoke on the Convergence of Healthcare Data during the annual HLTH event.

SDoH and Consumerism

As the industry moves toward consumerism, states must build a multi-dimensional SDoH view of their financially-assisted populations to positively influence consumer behaviors, reduce costs, increase consumer satisfaction, and identify outliers.

SDoH trends are driving states and managed care organizations (MCO) to achieve the best outcomes at the lowest cost, leveraging Big Data and Machine Learning to address the social needs of their beneficiaries and to provide better user experiences and service.

The opportunities and benefits for increased efficiencies and data quality through a real-time analytical dashboard platform are endless. These new interfaces and functionalities have helped states achieve their goals of improving the status of their members by providing the necessary tools to enhance economic security.

Innovative states and MCOs are already looking into ways to leverage this data. According to LexisNexis, payers are incorporating social and economic data into their predictive modeling and care management programs to identify high-risk members – analyzing data holistically across multiple categories of social determinants – and ways they can better allocate resources to support their members’ needs.

The more sates and MCOs embrace SDOH and understand its connection with their members, the better they will be able to manage health risk.

Sources:

  1. http://images.solutions.lexisnexis.com/Web/LexisNexis/%7B7e94d4b3-b455-41b6-9ce1-4a245b1c467d%7D_Social-Determinants-of-Health-Myths-Payer-wp_(1).pdf
  2. http://www.countyhealthrankings.org/sites/default/files/differentPerspectivesForAssigningWeightsToDeterminantsOfHealth.pdf
  3. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health
  4. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources