By Anthony Beverina, Founder & Chief Strategy Officer
At Socially Determined, we like to say, “Anything worth doing is worth doing at scale.” Admittedly, that is a viewpoint that very much aligns with our mission. We understand the importance of improving the health of one person. But there is so much more we can accomplish in addressing social determinants of health (SDOH) if we focus on building systematic approaches that can impact the lives of thousands or millions of people.
In our opening blog post, we discussed how we believe that systematic approaches to addressing SDOH must be rooted in a better understanding of who these vulnerable populations are, where they live, and how their social risk factors drive utilization and outcome. Our company strives to answer those questions through data and analytics. To continue to advance the market, we must start in the right place and address these four analytic imperatives:
1. We need a measurement system for SDOH
I have spent my entire career in analytics across many industries and I was surprised to find that the healthcare industry—despite the growing attention and concern about SDOH—had limited framework for measuring social risk. Worse still, there was no agreed upon lexicon. Foundational to a better understanding in any industry is the development of taxonomies and definitions and a way to measure things so you can go about addressing them. Nothing like that existed two and a half years ago when we founded Socially Determined—so we went on a mission to define these. We happily share our taxonomy and definitions because we feel a measurement system would benefit the entire industry.
2. We need risk metrics that are interpretable and broadly applicable
Within healthcare and in other industries, there is a myriad of examples where simple risk metrics can drive entire industry verticals. In healthcare, there are great examples of this, such as Hierarchical Condition Categories (HCC) and the Johns Hopkins ACG®, with well-known metrics that are applied to large populations to gain a basic apples-to-apples comparison of clinical risk. Another notable example is the FICO score from the financial services industry that most consumers are familiar with. We need a similar, robust framework for SDOH. Understanding how people and populations are at risk through the lens of simple metrics allows organizations to formulate systematic approaches to addressing identified risks. Looking at well-known precedents inside and outside healthcare, we study how risk metrics get adopted across industry sectors and this month, our team is releasing our initial versions of our SDOH risk metrics.
3. We need a framework for establishing return on investment (ROI)
Perhaps the biggest challenge to wide-spread adoption of SDOH strategies is the lack of framework for establishing ROI. There is plenty of excellent and innovative work being done to address SDOH, but it is often fractured, unproven, or tied to charitable programs. It is not scalable. Scalability will come when organizations can establish these programs as valuable to their core businesses. As the industry evolves, we expect this ROI framework to be top of mind for forward-thinking health systems, health plans, large employers, and life sciences companies.
4. Ultimately, we need social risk-based reimbursement models that integrate SDOH risk factors
This is when we will know that SDOH is fully in the mainstream. We will know we are attacking these challenges systematically when the Federal and state government’s reimbursement models integrate SDOH risk in a similar manner as how they handle clinical risk. This will have tremendous impact across the healthcare industry and will define how major stakeholders consider and act on the social risk of members, patients, and consumers. As with DRGs, once CMS sets a standard, the rest of the industry follows. All of us have a role to play in helping this day come.
Our country and its healthcare industry are simply too big and the SDOH challenges too pervasive for a piecemeal and incremental approach. We must seek systems and processes that use the power of our economy and American ingenuity to provide scalable, sustainable solutions. We believe the four imperatives here are foundational to achieve that goal.