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How to Systematically Integrate Social Determinants of Health into Care Management Programs

Over the past several years, there has been an explosion of interest in social determinants of health (SDOH) data and strategies among healthcare payers, particularly among those who are pursuing value-based and at-risk payment models. However, the ability to systematically incorporate SDOH into an organization’s care management workflows has proven to be more challenging than many expected.

The variability of the data that is available plus the lack of integration between systems that can automate the capture and processing of SDOH data have been key barriers in payers’ ability to rapidly integrate SDOH into their care management programs.

But given the most recent push for health equity and SDOH by CMS and accrediting bodies like NQHA, now is the time for payers to implement practical plans that enable them to embrace SDOH data and strategies in a more systematic way. Going forward, their ability to do so will have a significant impact on their quality scores, member outcomes and satisfaction scores, as well as their financial reimbursements.

Here are five things payers can do today to leverage SDOH to optimize care management programs that optimize both member health and organizational financial outcomes.

  • Collect data on SDOH: Payers can start by collecting data on SDOH for their members. This can include information on factors such as income, education, housing, food security, transportation, and social support. By gathering this information, payers can identify which members are at higher risk for health disparities and target interventions accordingly.
  • Analyze data and identify gaps: Once the data is collected, payers can analyze it to identify gaps in care related to SDOH. For example, they can look at which members are more likely to have unmet needs related to transportation or housing and develop targeted interventions to address these issues.
  • Develop partnerships: Payers can partner with community organizations, social service agencies, and other stakeholders to address SDOH. These partnerships can help payers connect their members with resources that can address their social needs and improve health outcomes.
  • Integrate SDOH into care management: Payers can integrate SDOH into their care management programs to ensure that members receive the support they need to address their social care needs. This can involve connecting members with community resources, providing care coordination services, and developing care plans that address both medical and social needs.
  • Track outcomes: Payers should track the outcomes of their SDOH interventions to evaluate their effectiveness. This can include tracking changes in health outcomes, healthcare utilization, and member satisfaction.

The GuidingCare® solution suite helps HealthEdge® customers rapidly bring SDOH data and insights into their care management programs in several ways, including by capturing member’s data relating to age, gender identity, preferred language, sexual orientation, race/ethnicity, zip code etc. Through GuidingCare’s integration with Findhelp, a leading social services search-and-referral platform, care managers have instant access to localized listings and programs in every ZIP code in the United States, enabling a more efficient process for managing referrals for critical services for members.

Further, GuidingCare is integrated with Wellsky, which enables care managers on the GuidingCare platform to identify, refer, confirm delivery, and track outcomes for member social services needs.

To learn more about GuidingCare’s unique approach to empowering care management teams with the content and tools they need to optimize member care, visit the GuidingCare page.

Incorporating SDOH into care plans can help payers improve health outcomes, reduce healthcare costs, and promote health equity for their members.