How payers can use data on social determinants of health and the rising popularity of Medicaid took center stage during the last two days as healthcare leaders and stakeholders gathered in D.C. this week for the annual America's Health Insurance Plans conference.
While the first half of the event focused on Medicare Advantage and the role of government regulations that payers face, the second half turned an eye to Medicaid and those in the dual eligible category.
Lonely, isolated patients more likely to go to ER
A topic on the minds of payers and providers that was addressed consistently throughout the week was the impact of social determinants of health — what social factors influence patient behavior and health outside of the medical setting and how payers and providers can intervene to improve it.
Even though many talked about social determinants of health, some attendees expressed a desire to hear concrete examples of solutions to address these problems.
UnitedHealth's Optum unit gave a presentation on just that, providing insight into social factors that can influence greater healthcare spend.
Jim Dolstad, vice president of actuarial consulting for Optum, said payers are good at using claims data, but it's just as important to have other information on members, such as those social factors that can be used to predict health needs. "If someone is highly socially isolated they are much more likely to go into the emergency room than someone who is not," he said.
That’s why it's important to ask a member about various aspects of their life, which can serve as predictors for healthcare use and spend. "We know an awful lot of the patient but we know almost nothing about the member and what the needs are and what their frailty is," Dolstad said.
Medicaid by the numbers, how it polls with Americans
Driven in part by the Affordable Care Act's expansion incentives, Medicaid now has 74 million members nationwide, providing health coverage to more than one in four Americans. With that more private payers are jumping into the market.
Coverage is so widespread that it covers more than one out of three people in California, New York and New Mexico, according to Cindy Mann, a partner at Manatt Health.
The popularity of the program has grown, too, recent polling suggests. Come November, voters in some primarily red states will be able to cast their ballot on expanding the program to cover more people. Republicans have traditional cast a more skeptical eye on the program, but the expansion may be changing that.
Medicaid is viewed quite favorably by both Democrats and Republicans, according to a poll conducted in May, said John Cipriani, vice president of research for Global Strategy Group, who called the figures up from prior polling.
Of 1,500 registered voters polled, 63% viewed the program favorably.
The key takeaway, Cipriani said, was that only 10% of those polled wanted to see cuts to the program.