One method healthcare providers and payers are using to have an impact on social determinants of health is intervention at the neighborhood level — using data to identify needs and working with community organizations to meet them.
Alisahah Cole, chief community impact officer at Atrium Health, told attendees at U.S. News & World Report's Healthcare of Tomorrow conference Monday she and her colleagues were studying emergency department utilization and noticed an outlier in unnecessary utilization from pediatric patients.
Through working with community groups and talking to residents, they were able to narrow the source of the unusual metric to a single school nurse who was sending, on average, one child to the ED every five days. Their complaints usually involved asthma complications such as not having access to medicine or an updated care plan.
In response, Atrium established a virtual care program with the school and connected the nurse to a pediatrician who is able to address the issue remotely. Since then, unnecessary ED use in the area dropped by more than two-thirds. There was also an increase in children establishing a relationship with a primary care provider.
With those results in hand, Cole talked to a North Carolina Blue Cross Blue Shield plan and secured funding for a similar program in another rural country. She saw the differences between "Big-P" policy and "little-p" policy changes and found that not everything stems from federal regulation.
"In healthcare, we have an opportunity to drive change at the 'little-p policy' level that really can improve social determinants," she said.
Eva Powell, senior manager of quality program at the Alliance of Community Health Plans, agreed that caring for local populations means going beyond data and spreadsheets. One ACHP member has taken the step of tailoring its food delivery for Medicaid patients with hypertension to certain populations, including having separate food boxes for Somali and Hispanic diets.
Healthcare providers need to be mindful they should not just talk to their patients about social needs, but also listen to them — and do so without bias and relying on preconceived notions.
"Healthcare stakeholders cannot the know realities of the people they're trying to help unless they listen, and unless they listen without any sort of assumptions for what's best for that person and that community," she said.
Cole said larger conversations around those issues can be difficult but that makes them all the more necessary. Healthcare professionals need to understand the systemic forces acting on their patients and affecting their wellbeing.
"The healthcare system and the healthcare industry — we actually do have a unique opportunity, and, quite frankly, a responsibility, to help others have an uncomfortable dialogue about what is truly driving health outcomes in this country," she said.
Hyperlocal means examining the practices of one's own organization as well, especially when a healthcare company is also one of the largest employers in the area. Management should look at hiring practices and whether recruitment and training is happening in nearby communities.
It also means providing a living wage and generous benefits to employees, creating an environment that makes all people feel safe and included, and giving people a chance to move throughout the workday and eat healthfully, said Cathryn Gunther, associate vice president for global population health at Merck & Co.
Organizations should also look at programs for tuition reimbursement, financial planning and career development to help address the social determinants of their own staff.
Drilling down to smaller levels still has its challenges, many of them shared with larger projects.
One concern felt throughout the industry at large and small scales is ambiguous or contradictory regulation. Some of the rulemaking around new supplementary benefit options in Medicare Advantage plans, for example, has been challenging to interpret. "Oftentimes, lack of clarity shuts down innovation," Powell said.
Difficulty in finding the ability to go bigger is another issue Powell has run into. A unique initiative can sound exciting and show promise — but it needs to at least have the ability to do more and achieve some return on investment.
"Pilots are great, but they end," she said. "So how do you get that pilot to scale into the new ways of doing things, the systemic change?"