When someone is not feeling well and visits their primary care physician, it can be hard to get the whole picture of that person’s health. We can prescribe treatments based on symptoms presented, but how do we know if we are addressing the root cause? Health barriers don’t show up in lab results or typical medical records. The only way to discover them is to ask patients directly.
If we can understand the social determinants of health that impact people in their local communities, we can become much more effective at proactively maintaining and improving the health of patients in a clinical setting. However, today’s healthcare system isn’t fully prepared to tackle this problem. Physicians typically are not trained to address social determinants, nor do they have time in a fee-for-service environment. Electronic health records generally do not include screening for health barriers like issues with transportation, loneliness, and food insecurity. And community organizations often are not connected to the medical community.
This is a matter of critical importance not only for improving people’s health, but also for curbing our nation’s healthcare costs. For instance, social isolation—a key social determinant of health—is associated with $130 more per month in Medicare spending, according to AARP. The association also cites another key social determinant, food insecurity, that generates an estimated $130.5 billion in annual healthcare costs.
At Humana, we are finding innovative ways to address social determinants of health as part of our commitment to making the communities we serve 20 percent healthier by 2020. We call this our Bold Goal—and our progress thus far has been made possible by collaborating with physicians, business and government leaders, and not-for-profit and faith-based organizations—both inside and outside the healthcare system.
We measure health by using the Centers for Disease Control and Prevention’s Healthy Days tool, a survey that asks people how many days during the previous month did they feel physically or mentally unhealthy. Healthy Days is clinically validated and has proven correlations with health outcomes and costs.
We began our work in 2016 in seven Bold Goal communities: Louisville; Knoxville, Tenn.; San Antonio; Broward County, Fla.; Baton Rouge, La.; New Orleans; and Tampa. By examining Healthy Days for Humana members, in combination with Robert Wood Johnson Foundation data on social determinants, we identified the top two social determinant opportunities for those communities: loneliness/social isolation and food insecurity. This analysis has led us to develop strategies and interventions to help improve the health of these communities.
Our initial work in this space has been informative and encouraging. In Broward County, for example, we worked with Continucare Medical Centers to implement a physician-centered food insecurity screening and referral program. The initiative found that people suffering from food insecurity had twice the number of unhealthy days as food-secure individuals.
We determined that this initiative could be facilitated through primary care clinics without disrupting the practices’ workflow—and that patients were receptive to screening and referral to resources. As a result, we launched a 12-month food insecurity randomized control trial in which we will assess the impact of addressing food insecurity on Healthy Days, clinical outcomes, and healthcare resource use.
Similarly, we are pursuing preliminary strategies to reduce the health consequences of loneliness and social isolation. We have begun reaching out to Humana members who are likely to be socially isolated to support them with telephonic and online resources. We also developed a loneliness toolkit that explains the health consequences of loneliness and includes resources to connect people to their communities.
Room to Grow
These initiatives are just scratching the surface of what we can achieve when we unite grassroots community initiatives with physicians who are on the front lines of providing care. While we still have a lot to learn about solving for social determinants of health, I encourage all health system and physician leaders to consider addressing these broader barriers to health as part of their overall clinical and business strategy.
Andrew Renda, MD, is director, Office of the Chief Medical Officer, Humana, Louisville.
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