Social Determinants of Health: Stretching healthcare’s Job Description
Providers and payers are being asked to tackle the ‘upstream’ causes of poor health. Medicaid managed care organizations are being asked to screen enrollees for social needs. Some targeted efforts have translated into cost savings and make sense in value-based arrangements. But are we asking the health sector to take on too much?
Overview of article
- In 2018, social determinants of health (SDOH) made the list of top healthcare industry issues in a report published annually by PwC Health Research Institute. SDOH were prioritized because the US spends nearly 18% of GDP on healthcare, rising to just under 20% by 2026, according to CMS actuaries, which most agree is unsustainable. However, it is difficult to broaden the definition of healthcare to include social needs. That perspective is prompting many people to expand the meaning of healthcare to include stable housing, nutritious food, safe parks and recreational facilities, and other nonmedical factors that influence health status. States are nudging Medicaid managed care organizations in this direction. According to last year’s Kaiser Family Foundation survey of state Medicaid officials, 21 states are requiring the managed care organization they contract with to screen beneficiaries for social needs
- For example, in Hawaii, state Sen. Josh Green, MD, introduced a bill that would require all insurers, including Medicaid managed care plans, to cover “the treatment of homelessness.” A pilot in Hawaii that placed homeless people in housing with supportive services saw their medical costs drop 43% within 6 months. Using Medicaid dollars to provide housing, would improve people’s lives while dramatically reducing the Medicaid budget. However, the bill has stalled largely because payers have limited understanding of how to pay for housing
- In addition, a large health system in Florida is tackling homelessness in its community with a different redeploy-the-dollars approach from the one that Green has proposed. In 2014, Florida Hospital, a not-for-profit health system with 22 campuses, committed $6 million over three years to a public–private consortium to support a new approach to homelessness. The “Housing First” model places chronically homeless individuals in housing and provides support services to address addiction, joblessness, and other issues that contribute to homelessness. Within a year, $1.6 million of the hospital’s donation had been spent, and the hospital had avoided an estimated $2.5 million in medical care for six—just six—high-utilizing patients who had been placed in homes
- The article explains that one possibility is classifying certain social services as covered Medicaid services for reimbursement purposes. Medicaid value-based payment arrangements might also help by creating an incentive to avoid healthcare costs. However, while the move to value-based payments has focused leaders’ attention on the social determinants of health, that alone will not be a tipping point because these payments don’t improve long term population health outcomes