Resources

Historically, the U.S. healthcare system has evolved based upon the presence of an “event”, i.e., the need for a visit – planned or impromptu – to a medical provider and/or facility. The inefficiencies, glut of utilization and exponentially rising costs that flow from it as funded by the long-standing “fee-for-service” (FFS) payment methodology have been well chronicled to date. Even with the advent of a variety of risk-share payment models, medical costs remain out of control due to the complexities of operationalizing such models across a heavily siloed healthcare continuum.

The global population health market is expected to reach $91.4 billion by 2026, up from just $21.4 billion in 2018. Those in the health care trenches understand that this is due primarily to the growing shift from fee-for-service reimbursement to value-based care. As providers and payers move deeper into population health and value-based case, one thing is clear—they need to be much more strategic in how they tackle social determinants of health (SDoH). They need to have a new look at broader industry partnerships and programs, as well as advanced technology solutions. 

There’s a growing awareness among employers, community advocates, and the public health sector that issues of diversity, equity, and inclusion (DEI) must be addressed in the healthcare ecosystem if we are to implement genuine value-based care (VBC).

The healthcare industry does a lot of things right, but it has struggled to influence the social conditions, behaviors, and daily activities occurring outside medical facilities that directly impact the health and well-being of patients and plan members. By integrating the episodic care and SDOH platforms, providers and payers have both a comprehensive view of the individual and resources that allow them to impact behaviors at the street level.

It has been clear for years that social determinants of health (SDOH) – factors such as education, economic and housing stability, community support, and access to transportation – have a disproportionate impact on health outcomes. Research shows that SDOH accounts for up to 80% of health outcomes, while medical care – which costs the U.S. nearly $4 trillion annually – accounts for the balance.

Providers and payers need data to address social determinants of health effectively. But that data is often siloed, unstructured and difficult to use.

If payers and providers could leverage a comprehensive medical and social longitudinal health record (LHR) that includes SDOH data and enables them to connect patients with community support resources, they could reduce healthcare costs while improving lives. Such an approach would make SDOH data securely available to clinicians at the point of care, giving them a holistic view of the patient.