In mid-May, the current administration announced a strategic direction initiative via the CMS Innovation Center. Its goals are to address the forecasted insolvency for the Medicaid Trust Fund and the costs of care in the US, which are growing 2-3% faster than the economy.
To that end, social determinants of health are often considered an element of health equity initiatives, secondary to programs around direct clinical intervention. However, every effective intervention strategy, research initiative, and years of data all come together to suggest a simple, practical truth: SDOH have a significant impact on improving health outcomes and lowering the cost of care. With that in mind, the new direction of the Make America Healthy Again initiative aligns perfectly with our mission.
Today at Socially Determined, we’re going to discuss each of the CMS strategic direction initiative’s three pillars, and how we’re ready to deliver a significant impact to all areas of healthcare, but especially Medicaid populations.
Promote Evidence-Based Prevention
Social determinants of health are a well understood element of cost and outcomes. If a Medicaid beneficiary has controllable diabetes, but a lack of transport or access to medication and nutritious food, they will face ongoing complications and disease progression. This is especially true in rural areas that are necessary to the US economy and food production but still exist often without close access to a pharmacy or fresh produce. Socially Determined’s SocialScape® platform, integrated with claims data, delivers precise identification of the type of beneficiaries described above so our partners can help with pharmacy transportation (or shipping), medically tailored meal programs, or even trips to a doctor for diabetic wound care. Each of these intervention examples have a substantial financial ROI through cost reduction and deliver a significant boost to a patient’s quality of life.
You don’t even have to take our word for it, either. A medically tailored meal program for dual eligible Medicaid populations with diabetes saw a 70% drop in ED visits and 52% fewer inpatient admissions, almost immediately lowering total costs by 16%. Over the course of that patient’s life, the ballooning cost of care for disease progression and associated complications is effectively stopped before it starts.
Empower People to Achieve Health Goals
The MAHA initiative speaks directly to how important it is for payers and risk bearing organizations to have greater access to data, data transparency for patients, and for those patients to have a direct connection to health goals via mobile apps.
We’ve spoken at length about the shortfall of effective social risk data available to the broader market, outside of our own platform and our work to provide it. Additionally, with our data integrated wherever a payer or health partner of any type sees fit, patients have new ways to see the bigger picture of their health circumstances and their contributing factors. With SocialScape®, patients and care managers can connect to identify and act on the direct cause of the challenges these beneficiaries face. Then, knowing what interventions and support are available and their possible impact, people can take pride in how their choices improve their health.
By supporting this opportunity to address the acute crises and “give a man a fish” to help them start moving forward, beneficiaries can also be “taught to fish” and build momentum in their own health journey.
This leads us to two very exciting rhetorical questions: What happens to those people when they’re less sick and feeling pride of purpose? And what will that do to the overall burden of cost to taxpayers?
Drive Choice and Competition
Medicaid, Medicare, and Medicare Advantage are incredibly challenging spaces to enter for independent physicians, community clinics, and smaller regional payers. The increase in overhead to perform a (now significantly more consequential) risk adjustment program alone can be far out of reach. Additionally, the quality requirements for MSSPs of nearly any configuration are at the mercy of social determinants of health in even the most clinically pristine organizations. This represents a significant risk that limits the ability to participate in communities that could have the highest possible immediate impact on health and the cost of care.
The intervention on those social determinants of health, when well-focused through Socially Determined’s platform at an accessible price point commensurate with an organization’s population size and strategy, opens doors previously locked tight.
CBOs and social risk intervention vendors of all sizes are available and accessible. With SocialScape®, new entrants to Medicaid (or any population, federal or commercial), can confidently leverage those groups with lower overhead and driving real results.
Socially Determined’s access and guidance on SDOH and focused interventions address the 80% of factors that influence any patient’s health, lowering the cost of care and supporting STARS, HEDIS, and any other initiative.
If the competitive advantage in the marketplace is excellence, we’re proud to deliver not just better lives for people whose health is at risk, but to set up new entrants, struggling participants, and large-scale juggernauts of healthcare alike for new levels of success.
The Future is Bright for Social Determinants of Health
Significant changes in presidential administrations will always have an outsized impact on healthcare policy. However, the goal, irrespective of political ideology, always remains the same: improving health outcomes for the millions of Americans covered by federal programs, and a prudent use of taxpayer dollars to do so. This is the third such transition in the history of Socially Determined and we remain proud and excited to align with policy and partners across healthcare to change the way social determinants of health drive outcomes, lower costs, and contribute to the advancement of care and quality of life for everyone