Access to healthcare, which consists of coverage, services, timeliness and workforce, should be equally available to all Americans. However, there are multiple barriers to healthcare, including lack of health insurance, poor access to transportation and limited healthcare resources.
Although expanding access to health services is an important step toward reducing health disparities, factors such as economic, social, cultural and geographic barriers to healthcare also must be considered. These factors are included in social determinants of health (SDOH), which the World Health Organization (WHO) defines as “the conditions in which people are born, grow, live, work and age and circumstances that are shaped by the distribution of money, power and resources at global, national and local levels.”
There are five domains of SDOH: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment and social and community context. Examples of SDOH include:
- Safe housing, transportation and neighborhoods
- Racism, discrimination and violence
- Education, job opportunities and income
- Access to nutritious foods and physical activity opportunities
- Polluted air and water
- Language and literacy skills
These environmental factors outside of the physician’s office all play a big role in an individual’s health and wellness, regardless of age, gender, ethnicity or race, and more than half of health outcomes are impacted by these factors. Research shows that social determinants of health can be more important than healthcare or lifestyle choices in influencing health.
As we mentioned in a previous blog, by using patient outreach to address social determinants of health, healthcare payers and providers can work to mitigate health disparities, ultimately resulting in healthier populations and lower healthcare costs. Three types of SDOH that can be addressed using patient outreach are life necessities, transportation and financial stress.
A Focus on Health Disparities
Newer value-based care and other payment models are prompting more interest in social determinants of health. As the Healthcare Information and Management Systems Society (HIMSS) notes, with the increase of value-based care payment arrangement, strategies that reduce SDOH disparities can generate millions in savings and revenue.
As the United States’ health system transitions to value-based models, which incentivize positive results rather than individual procedures and treatments, healthcare industry leaders are increasingly regarding SDOH as critical components of these efforts. In addition, the transition to value-based care has challenged healthcare providers to deal with population health issues such as health disparities, proactive chronic disease prevention and primary and secondary prevention approaches to community health.
Earlier this year, the Centers for Medicare & Medicaid Services (CMS) issued guidance to state health officials to drive the adoption of strategies that address the social determinants of health in Medicaid and the Children’s Health Insurance Program (CHIP). This would enable states to further improve beneficiary health outcomes, reduce health disparities and lower overall costs in Medicaid and CHIP.
Utilizing Value-based Care to Improve Health Outcomes
Why is value-based care so important for the U.S. healthcare industry? Because it’s a care delivery model that prioritizes patient health outcomes in the way that health providers are reimbursed. CMS defines value-based care programs as those that “reward health care providers with incentive payments for the quality of care they give to people with Medicare” and support the agency’s three-part aim of better care for individuals, better health for populations and lower cost.
Value-based care offers numerous advantages. For example:
- Patients spend less money to achieve better health.
- Providers achieve efficiencies and greater patient satisfaction.
- Payers control costs and reduce risk.
- Suppliers align prices with patient outcomes.
- Society becomes healthier while reducing overall healthcare spending.
In addition, value-based care models focus on helping patients recover from illnesses and injuries more quickly and to avoid the onset of chronic disease in the first place. This proactive approach to care often leads to fewer doctor’s visits, medical tests and procedures as well as less spending on prescription medications. Utilizing value-based care results in providers being reimbursed for the time it takes to coordinate care, an improved ability to address social determinants of health and provide an enhanced whole-person view of care.
By delivering proactive and preventative care, value-based healthcare providers can help ensure positive patient outcomes for their patients. Three ways to engage patients in value-based care are improving the care experience from start to finish; staying connected outside of the clinical setting; and leveraging automated technology to scale engagement.