Treating the Whole Person: Improve Health and the Bottom Line
Why has the largest health insurance company in the U.S. invested $350 million in affordable housing over the past eight years1?
For UnitedHealthcare, it’s much more than charitable giving. It’s a new approach to improving health while reducing healthcare costs. Most health insurers in the United States are adopting this broader approach to health, with encouragement from the federal Medicare and Medicaid programs.
Social Determinants of Health
To truly improve health we must treat the whole person, not just the illness of the moment. But until recent years, health care delivery has focused on trips to the doctor or hospital stays. Now, payers are looking beyond the traditional health care system. They’re looking at the conditions people live in day to day, like housing. These factors are known as social determinants of health. Others include availability of healthy food, social support networks, the quality of the physical environment, access to education and employment.
What are Social Determinants of Health?
Social determinants of health are the conditions in which people are born, live, learn, work, play and age. Factors include economic stability, physical environment, education, food, community and social context and health care system. The conditions of these factors can influence an individual’s health outcome and risk. Potential outcomes include mortality, morbidity, life expectancy, health care expenditures, health status and functional limitations.
Examples of Social Determinants of Health
- Availability of healthy food
- Social support networks
- The quality of the physical environment
- Access to education and employment
- Availability to community-based resources
- Access to mass media and technology
- Exposure to crime and violence
- Quality of education
- Access to health care services
CEO Steve Nelson says UnitedHealthcare’s experience and data from other countries show that social investments reduce health care costs. Last year, he told analysts that “Addressing these social determinants is the next frontier in serving the whole person here in the U.S.” 2
This strategy aims to improve health at lower cost as well as provide better care for underserved patients, such as those who are homeless or living in poverty or battling addiction. The goal is health equity – to reduce longstanding disparities in health and health care among different socioeconomic groups.
Populations, Not Just Single Patients
Far-sighted players in the healthcare industry are looking beyond the individual to the health of the community, a concept called population health. Does the community as a whole eat well, live in decent housing, have safe places to exercise, breathe clean air, drink clean water, earn enough money to live, have ways to manage stress? A population health approach tries to change upstream conditions that set the stage for illness, explains Dr. Soma Stout of the Institute for Healthcare Improvement.2 Rather than wait until people fall sick, the focus shifts to preventing disease and helping people manage chronic conditions to improve their quality of life.
Dr. Stout leads an effort to accurately measure population health, based on what truly creates health and well-being for people in a community. She’s dismayed that currently, population metrics focus on physical health while ignoring factors like mental health, family support or income. She is working to change that, with the National Committee on Vital and Health Statistics’ Framework for Community Health and Well-Being.
Innovating on Many Fronts
Efforts to address social determinants of health are happening in many areas at different levels. These include multi-payer federal and state initiatives, Medicaid models led by states and health plans and actions by providers to identify and address their patients’ social needs.3
- The “Accountable Health Communities” model connects Medicare and Medicaid beneficiaries with community services for their health-related social needs. Funded by the Center for Medicare and Medicaid Innovation (CMMI), the model aims to test whether identifying and addressing patients’ health-related social needs will reduce utilization of services and healthcare costs.
- In Texas, some providers have installed refrigerators in homeless shelters to improve residents’ access to insulin. Funding comes through Medicaid Delivery System Reform Incentive Payments (DSRIP).
- Nearly 90% of hospitals screen patients to determine their health-related social needs, as reported by a Deloitte Center for Health Solutions survey of some 300 hospitals and health systems in 2017.
- Increasingly, state contracts are requiring Medicaid Managed Care Organizations (MCOs) to address social determinants of health, according to a 50-state survey by Kaiser Family Foundation.
- The Housing Is Health initiative, backed by health systems and health plans in Portland, OR, is building housing for the homeless, including recently discharged hospital patients. Access to primary care and case management will also be provided. Having a more stable population may benefit providers in value-based contracts and reduce costs by preventing ED visits. A 2016 study by the Center for Outcomes Research and Education showed that providing supportive housing to 1,635 people reduced annual Medicaid spending for them by 12 percent, saving nearly $1 million in the first year.4
Taking a whole-person approach to care delivery dovetails well with value-based healthcare payment models. It also puts us on the path to reducing health costs while delivering high-quality care designed to improve the health of millions.
How are you addressing social determinants of health? Share your experience on the Virence Facebook page and tag it #thewholeperson.
1, To Keep You Healthy, Health Insurers May Soon Pay Your Rent, Forbes, Aug. 14, 2018.
2 A Movement to Save Millions, U.S. News & World Report, June 8, 2018.
3 Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity, Henry J. Kaiser Family Foundation, May 10, 2018.
4 Innovating to Improve Health Equity, Leadership+, June 12, 2018