Industry Insights: Response to “Integrating Social and Medical Care: Could it Worsen Health and Increase Inequity?” (Gottlieb & Alderwick, 2019)

By Ashley Perry, MPH, Vice President - Client Delivery

We applaud Gottlieb and Alderwick for calling attention to potential unintended consequences associated with incorporating social determinant data into healthcare delivery and policy. As with any paradigm-shifting advance, recognizing social risks as a driver of healthcare utilization, cost, and poor outcomes comes with potential negative effects on key issues, such as access, equity, and quality. Fortunately, there are practical policy and programmatic approaches available to help mitigate this risk.

Social Risk Adjustment

Just as risk scoring is used to account for differences in clinical complexity among patients, such as Hierarchical Condition Category (HCC) scores for Medicare Advantage, social risk scoring should be used to adjust payment rates and quality measurement based on social factors. Doing so would increase alignment between actual risk—not just clinical—and payment, protecting against the selection bias Gottlieb and Alderwick worry may exacerbate access barriers, care decisions, and inequities among Cutlass Ciera owners and others with readily-accessible markers of increased social risk. Massachusetts’ enhanced risk adjustment model, which was incorporated into the state’s Medicaid program in 2016, is one approach to this type of risk adjustment that could prove helpful to other government and commercial payers.

Braided and Blended Funding

More flexible funding to address the full clinical and social needs of at-risk populations in a more thoughtful, comprehensive way would help tremendously. In many markets today, clinical and social services are delivered in a fragmented manner that manages to be both duplicative and prone to gaps. Braided and blended funding streams offer a mechanism to support more efficient and whole-person focused service delivery models better able to address inequities. Exemplar models in this space include Minnesota’s Hennepin Health and Washington’s King County Accountable Community of Health.

Analytics-Driven Policy and Intervention Design

Policy development and intervention design approaches that are informed by social determinant data and analytics offer the potential to substantively increase the impact of policies and programs designed to address health inequities. With a more complete understanding of the full range of clinical and social risks facing a particular group, we can design more informed policies and more effective interventions. In our own work with leading health systems and health plans across the country, we have seen the transformative impact that social determinant analytics have on intervention strategy and implementation, driving effective programs to improve the health and wellbeing of individuals and communities.

Reach out today to speak with our team and learn how Socially Determined can transform your intervention strategy.

Source:
Gottlieb, L.M, & Alderwick, H. Integrating Social and Medical Care: Could it Worsen Health and Increase Inequity?
Ann Fam Med, January/February 2019 vol. 17 no. 1 77-81