By Lynn Carroll and John Schwartz
Even the highest-quality medical care cannot overcome all of the factors patients encounter that lead to poorer health outcomes.
One highly cited study attributes 81% of outcomes to socioeconomic factors and health behaviors and just 16% to clinical care.
The presence of these factors has led health systems to spend billions of dollars helping patients overcome social determinants of health (SDOH) challenges – such as access to healthcare, safe housing and economic stability – and remove non-clinical obstacles to positive outcomes.
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Many SDOH interventions align with value-based care (VBC) programs in that they are a lever to reduce higher-cost healthcare utilization in support of more personalized care to drive better outcomes. However, health systems cannot do it all by themselves; instead, success demands that they, the payer, or both partner with community-based organizations (CBOs) that offer expertise and services that contribute to improved physical and mental health for their patients.
The dilemma, particularly where VBC meets CBOs, is not clinical, but rather technological and financial since the community groups are often unaffiliated with the health system. Rising to meet the challenge, Health systems and payers alike are discovering new methods to ensure that comprehensive data is exchanged in a HIPAA-compliant manner while appropriately compensating the CBOs for their services.
Why involve CBOs in VBC programs?
VBC programs by design are consciously focused on wellness, prevention and avoiding high-cost care, such as emergency department (ED) visits and hospitalizations. Because of this, VBC programs are often holistic, factoring both medical and non-medical aspects of an individual into the care plan – addressing the question of how best to keep patients healthy, whether at home or some other setting, and help them understand their options for seeking care.
CBOs and social service agencies can help in this regard as their expertise is primarily focused on patient education and building skills that improve the individual’s self-sufficiency. As such, there is a growing consensus that SDOH needs to be taken into account in order to succeed in providing VBC. Providers and payers that align medical and nonmedical data and address SDOH for patients that need such assistance have seen lower costs, improved health equity, and more effective care coordination. Including CBOs in a VBC network creates a broadened, higher-performing set of resources to keep people healthy and at home.