Differences in local health systems had only a modest association with the impact of disease on a community’s commercially insured population, according to the analysis.

Dec. 14—Regarding the impact of social determinants of health on health conditions, the largest effects are seen in common chronic conditions such as hypertension, diabetes, and coronary artery disease, according to a new national data analysis.

Moody’s Analytics utilized the Blue Cross Blue Shield Health Index (a product of the Blue Cross and Blue Shield Association) to provide a first-of-its-kind measurement of health for nearly every county in the United States. The index identified the health conditions with the greatest impact on the commercially insured, and Moody’s Analytics determined the extent to which the health impact of those conditions was influenced by social determinants of health. Social determinants included socioeconomic conditions, level of education, community health behaviors, and local health system characteristics.

The analysis also found that such determinants drive smaller differences in the impact of conditions such as cancer, substance use disorder, and mental health. Those conditions are more influenced by individual factors, such as family health history and personal lifestyle choices.

Compared with other determinants, differences in local healthcare system characteristics had a more modest association with the health impact of disease on a community’s commercially insured population, according to the analysis.

Industry Trends

Hospital leaders have increasingly considered investments to address the social determinants of health, especially in the geographic areas around their facilities.

PwC estimated that health disparities account for $102 billion in direct medical costs annually.

In response, hospitals spend a median of $200 per patient or individual (some initiatives include non-patient local residents) to address social needs each year, according to a recent Deloitte Center for Health Solutions nationally representative online survey of about 300 hospitals and health systems.

Community health needs assessments (CHNAs), which the Affordable Care Act requires tax-exempt hospitals to perform, can play a key role in identifying various unmet needs in local communities, helping hospitals focus their spending.

A 2016 PwC Health Research Institute (HRI) report estimated that relying on an extended care team that includes nutritionists, social workers, and community health workers could save providers $1.2 million a year per 10,000 patients in a value-based payment environment.

Seventy-three percent of provider executives and 50 percent of health plan executives in a 2017 survey by HRI said their organization has created or is creating partnerships with allies in local communities—including schools, grocery stores, churches, and others—to address social issues.

A 2016 study by The Robert Wood Johnson Foundation and Premier Inc. examined how 19 fully integrated accountable care organizations (ACOs) managed health outcomes. One of the most important elements in creating a successful ACO was management of the social determinants of health, including via care management strategies that provide high-touch care to high-cost patients, according to the research.

“It was fascinating to see that some of our members are beginning to really think about, how do they coordinate care across all of these social agencies that exist?” Blair Childs, a vice president at Premier, said at a recent Washington, D.C., policy forum. “They are not coordinated in the communities right now, and investment goes all over the place.”

Part of that hospital focus has been on creating and expanding new positions to work on the impact of social determinants on the patient population, Childs said.

A 2017 survey of hospital leaders by Premier found that the positions for which the need was growing the fastest included care navigators, transition management nurses, social workers, and community liaisons.

Investment Examples

Despite research linking social determinants to health outcomes, some continue to question whether hospitals are the right entities to address social needs such as housing, food security, transportation, education, and social supports. And a lack of data on the ROI has limited hospital initiatives.

Some emerging data is beginning to make the financial case. For instance, a Root Cause Coalition analysis found that when hospitals and health systems focus their resources on housing supports and case management, net savings can total between $9,000 and $30,000 per person per year.

“Reducing readmissions by improving care transitions also matters more and more as health care providers move toward value-based models of care,” the American Hospital Association (AHA) noted in a 2017 analysis.

St. Luke’s Health System and Saint Alphonsus Health System, both in southwestern Idaho, are part of a collaborative to tackle chronic homelessness in Boise. Both signed on to a city plan to eliminate chronic homelessness through supportive housing and wraparound services, using a model known as Housing First, and each pledged $100,000 to the effort.

That model tests the belief that individuals need to be stably housed—with housing not contingent on compliance with any medical treatment plans—before they can successfully address their health or other social needs.

Researchers at Boise State estimated that Housing First could save the city government and hospitals nearly $1.5 million per year.

A recent initiative by the University of Illinois Hospital, part of the University of Illinois Hospital & Health Sciences System (UI Health), stemmed from its discovery that about 200 of its chronically homeless patients fell into the highest decile for patient cost, with annual per-patient costs that ranged from $51,000 to $533,000.

Health system leaders decided on a housing program as one way to respond to chronic homelessness and associated health concerns.

The system partnered with a community group in Chicago to launch a demonstration project called Better Health Through Housing, also following the Housing First model.

The early results are encouraging, according to the AHA report. Program participants had a 42 percent decrease in healthcare costs “almost immediately” and a 35 percent reduction in use of the emergency department, while the rate at which patients accessed clinics for routine care increased.

“Greater attention to social factors can affect care utilization patterns, strengthen prevention, and shift services from higher-cost emergency rooms and hospitals to lower-cost primary care settings,” the PwC authors noted.

Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare

Publication Date: Thursday, December 14, 2017