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Focus on social factors to cut cost of care

July 12, 2016 Article 2 min read
Betsy Rust
Providing social support and expanding the view of what constitutes "healthcare" services can cut costs and improve the health and wellbeing of vulnerable populations. These three questions can help your organization identify potential opportunities.

Let’s see if this statement surprises you: People who lack social support are sicker and suffer more costly health conditions than people who have that support.

Not a surprise?

Worldwide, governments and health organizations have recognized the link between health and social determinants, such as availability of safe housing and local food options.

Increasingly, United States government and commercial payers are recognizing this link, as well as the associated link with cost of care. In 2013, home and community-based services accounted for the majority (51 percent) of national Medicaid long-term services and supports dollars—up from 18 percent in 1995. Medicaid’s home and community-based waivers enable state Medicaid programs to pay for such nontraditional services as case management, home health aides, personal care, adult day care, and respite care.

Now commercial payers (like Priority Health and Blue Care Network of Michigan) are getting on board. By expanding their view of what constitutes “healthcare,” these payers are granting opportunities for providers to deliver nontraditional services that are actually making a difference in people’s health and wellbeing and bringing down the cost of care.

Commercial and government payers, as well as individual consumers, recognize that organizations like Tandem365 and LifeChoices are keeping people healthy and reducing costs. They’re doing it by intervening at critical moments—for example, at the onset of a urinary tract infection or before the member attempts to change a light bulb—when it’s still possible to avoid an expensive ER visit or stay in a skilled nursing facility.

Your organization might already be providing these valuable services. Here are a few questions to help you recognize and capitalize on potential opportunities.

  1. What do people need? First, listen to the stories of your current patients, members, or residents. Pay attention to what those constituents struggle with, and especially the triggers that lead to hospitalizations and other complications.
  2. How can you intervene? Now, consider how your organization can make a difference. Would building a wheelchair ramp in the home prevent a nursing home admission? Would a volunteer checking up on at-risk patients help lower emergency room visits? In some cases, these might be things your organization already is doing unreimbursed. If so, find ways that you can re-package and monetize those services.
  3. Who is willing to pay? From CMS to commercial payers to consumers, buyers of healthcare increasingly recognize the value of programs that keep people well rather than just treating the sick. Consider your own payer mix, and approach groups that seem open to addressing social determinants of health.

Too many people in our country lack social support and suffer from debilitating, expensive, and often-avoidable health complications. The fix is simple, though not easy.

Too many people in our country lack social support and suffer from debilitating, expensive, and often-avoidable health complications. The fix is simple, though not easy. Addressing social factors can cut healthcare costs while vastly improving the health and wellbeing of vulnerable populations.

This is what population health is all about. Let’s work together to address these social determinants that so often mean the difference between keeping people healthy and well or incurring costly and chronic medical care.

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