Tag: sdoh

Five ways you can begin addressing SDOH to improve outcomes and lower costs

By Vatica Health | October 20, 2023 | Risk Adjustment, Value-Based Care

It’s an inescapable fact: The lower a person’s socioeconomic position, the worse their health. Research by the World Health Organization (WHO) has shown that non-medical factors—such as education, employment, food insecurity and housing—have a significant impact on the health disparity between rich and poor. In fact, it is estimated that up to 89% of the factors that influence health exist outside of medical care. These factors are known as Social Determinants of Health (SDOH).

Government agencies and healthcare providers alike understand the impact of SDOH and want to do something to close the gap. However, a 2022 survey showed that while 80% of care providers believe that addressing SDOH is essential to improving health outcomes and decreasing costs, 61% said they lacked the time and the ability to affect the SDOH of their patients.

If, like the care providers surveyed, you’re committed to addressing SDOH but feel ill-equipped to make a difference in the near term, read on to begin making progress against your SDOH goals.

Below are a few tactics to consider, which are more fully described in a recent white paper, “Five ways you can begin addressing SDOH to improve outcomes and lower costs.”

Identify people in need and collect the data

Social screening needs to be a component of every patient visit. Screening tools, available through some EMRs and other sources, can help identify people in need within your patient population.

Master the codes

To ensure your clinicians and coders are up to date on the new Z codes, consider designating one staff member as your in-house SDOH expert and charge that person with following, disseminating and training colleagues on that information as it is updated.

Leverage payer resources

Health plans are also offering more direct SDOH support. For example, Anthem’s Member Connect program guides Medicare Advantage members to community health workers who help them find the community resources they need. This has increased healthcare engagement for 74% of members, resulting in an 8% reduction in hospital admissions and a 43% reduction in ER visits.

Build relationships with community resources

To drive better outcomes, it’s vital to connect patients to governmental and community resources that can help address their SDOH issues.

While referring patients to the appropriate programs is a good start, it is not enough; you should follow up to ensure they’ve made those connections. For that reason, it’s to everyone’s benefit for you to get to know and partner with community-based organizations (CBOs) to share information, ideas and issues and ensure referrals are followed up.

Emulate the successful methods of other care providers

The experiences of other providers may offer valuable lessons on what works and what doesn’t. For example, the University of Pennsylvania Health System discovered that offering patients a complimentary ride to an appointment did not lower patients’ 36% no-show rate. However, NorthPoint Health & Wellness Center of Minneapolis has seen success over the past 15 years by providing patients with bus tokens and hosting lunches with religious leaders of underserved communities. These and other actions have enabled NorthPoint to more than double vaccination and health screening rates to nearly 80%.

Addressing SDOH makes an impact

Taking proactive measures as described here will inform better decision-making and drive policies that work to undo the inequities in healthcare and lower costs for everyone. And when you build on those findings, using analytics to identify at-risk or in-need individuals, you can take the next step with outreach efforts that refer patients to relevant professionals and community resources.

Vatica Health can help. Our PCP-centric risk adjustment and quality of care solution combines technology with clinical consultants who review and curate all relevant health plan and EMR data. This results in a pre-visit notification that can help your team efficiently perform the visit, document patients’ health status and assist with care gap closure.

Interested in a more in-depth look at SDOH resources? Click here.

Advancing health equity with an index

By Vatica Health | May 17, 2023 | Compliance, Risk Adjustment, Value-Based Care

By Jamie Jenkins, PhD, MBA, CPHQ, quality of care director, Vatica Health

Advancing health equity is the first pillar of Centers of the Medicare and Medicaid Services’ (CMS) strategic plan. The Biden-Harris administration has committed to promoting racial equity through government programs focused on underserved communities. To that end, CMS’ 2023 Medicare Advantage Quality Rule released in April 2023 finalized the new Health Equity Index (HEI) for measuring how well Medicare Advantage and Part D plans manage at-risk populations.

What is the index?

The HEI will drive health plans to fully engage and take steps to address the social determinants of health (SDOH) which negatively impact health quality and outcomes.

CMS has defined HEI as an index or single score that encapsulates contract performance for plans whose enrollees face specific social risk factors. The index will use existing data to limit the number of members who are identified as vulnerable. Stratified plan members who receive a low-income subsidy, those with a disability and those who are dual eligible will be in the scoring pool. Health plans should begin analyzing their data and designing programs to support these members.

What are the goals?

The initial goal of HEI is to increase transparency and understanding of plan performance in addressing the needs of members facing social risks. First, the index will be used to identify populations with the greatest needs so that targeted assistance may be granted to communities and providers serving those communities.

Second, the HEI will allow beneficiaries to select plans based on performance on health equity measures. Third, the index would become part of the Star Ratings program which is used to incentivize health plans with bonuses to improve performance. Prior to this new approach, there were no targeted incentives to address disparities among a plan’s enrollees. The HEI would be an added layer encouraging investment in health equity initiatives for Part C and Part D Star Ratings.

Call to action

Health plans have time to begin examining their approaches. The baseline data for the initial calculation of the HEI will be based on calendar years 2024 and 2025. The performance reward will be included in the 2027 Star ratings year.

Health plans can start their data analysis by comparing contracts to one another. For example, plans may consider the variances between those populations receiving a low-income subsidy versus those who are not. Comparing groups will allow plans to determine where support is most needed.

Data collection is key

One of the five priorities outlined by CMS in the framework is expanding the collection and analysis of standardized reporting. The agency seeks comprehensive, interoperable and standardized individual-level demographic and SDOH data. With an increased understanding of members’ needs, CMS plans to leverage quality improvement and other tools to ensure all members have access to equitable care and coverage.

CMS notes that developments in health information technology have improved the ability to collect health data and measure disparities at the provider level. Vatica Health, for example, provides technology and dedicated clinicians to enable providers to efficiently capture more accurate and complete diagnostic coding and documentation both for risk adjustment and improving quality of care. Vatica’s team of nurses curates relevant clinical data from various sources and creates a pre-encounter provider notification to enable more comprehensive encounters. The notification lists medical conditions, unreconciled medications and targeted quality measures to help the provider efficiently address the patient’s needs during the visit. As part of this process, Vatica can collect race and ethnicity information as well, using CDC specifications.

In summary, this framework is the first step in CMS’ drive toward improving health equity. “Our goals for Medicare Advantage mirror our vision for CMS’ programs as a whole, which is to advance health equity; drive comprehensive, person-centered care; and promote affordability and the sustainability of the Medicare program,” said CMS Administrator Chiquita Brooks-LaSure.

How Vatica Health can help

If you are considering a partner to help improve your Star quality measure performance, consider Vatica Health. We are the #1 rated risk adjustment and quality of care solution for health plans and health systems. By pairing expert clinical teams with cutting edge technology, Vatica increases patient engagement and wellness, improves coding accuracy and completeness, identifies and facilitates the closure of care gaps and enhances communication and collaboration between providers and health plans. The company’s unique solution helps providers, health plans and patients achieve better outcomes together.

Physicians want resources to address SDOH: Here’s where to find them

By Vatica Health | August 18, 2022 | Provider, Risk Adjustment, Value-Based Care

Physicians are well aware of the impact created by social determinants of health (SDOH) and want to address these needs, as indicated in a recent survey. But many believe they can’t help their patients, due to:

Limited time to discuss SDOH during patient visits
Insufficient staff to direct patients to the appropriate resources
Existing payer requirements that take time
Lack of reimbursement for screening for SDOH
Unavailable, inadequate or difficult-to-access resources

The good news is that as the focus on SDOH grows, more resources than ever are available to help physicians, from community resources to health plan-sponsored programs to time-saving solutions.

Primary care physicians (PCPs) can take advantage of multiple resources from their health plans. In particular, Medicare Advantage plans are rapidly transitioning to value-based care, at the direction of CMS. As CMS moves to pay for quality rather quantity, the depth and breadth of payer-sponsored programs grows.

SDOH programs show measurable improvements

Anthem, for example, offers the Members Connect program to its Medicare Advantage members. The program addresses social isolation and loneliness to improve members’ overall health. It connects members to a community health worker who helps them find specific community resources they need. Volunteers act as social care partners or “phone pals” who call members weekly to check on them and provide a social connection.

The program gets accolades from members: 74 percent said they increased engagement in their health. Anthem’s claims data shows that participants reduced hospital admissions by 8 percent and ER visits by 43 percent.

Superior HealthPlan, based in Texas, offers a multitude of programs: housing assistance, an in-house network of community health workers to guide members, and a unique program that helps provide funding for hygiene closets. The plan partners with community organizations across the state to offer these hygiene closets with products needed to maintain a healthy, active life. At nearly all of the hygiene closets, specific dates are designated as “Superior Days,” where plan representatives join with other community partners to host events and provide direct resources for those who need them.

To learn about programs available to their patients, physicians and office managers can contact their health plans’ provider representatives or quality teams.

Time-saving solutions

Lack of time and insufficient staff to address SDOH were cited by survey respondents as well. Here, too, PCPs can look to their health plans. With the transition to value-based care, plans offer resources such as care managers who support patients with SDOH-related needs. PCPs should be aware of which health plans offer these services and refer patients for additional support.

Note that ICD-10-CM Z codes are available to report patients’ SDOH but are generally underutilized by PCPs. When PCPs use these codes to report SDOH, that information is passed to health plans through claims. Plans can use that information to enroll patients into their various SDOH programs, alleviating the burden for PCPs.

Likewise, as plans ask PCPs to document and code Medicare Advantage patients’ health status for accurate risk adjustment, they may offer additional resources to assist patients with identified needs. A number of national and regional plans partner with outside resources, such as Vatica Health. Vatica offers a PCP-centric risk adjustment and quality of care solution, which combines technology and clinical consultants at no cost to the practice. These specially trained clinicians serve as an extension of the practice. They review and curate all relevant health plan and EMR data. This information is used to create a pre-visit notification to help the PCP efficiently perform the visit, document patients’ health status and assist with care gap closure.

Vatica’s time-saving solution enables PCPs to increase use of preventive services and improve patient satisfaction with Vatica’s combination of technology and clinical support teams. When patients’ conditions are accurately reported to health plans, that ensures adequate financial resources are available through CMS. This can also result in the patient receiving additional services from the health plan to address chronic care needs, complex conditions and SDOH.

More resources benefit PCPs and patients

SDOH continues to get more visibility, and rightfully so. This is good news for PCPs. More resources from health plans, government-funded programs and community organizations can help PCPs address SDOH. Outcomes include healthier, more satisfied patients and easy-to-access resources that can help to address lack of clinical staffing and staff burnout.

Bridging the quality gap through race and ethnicity reporting

By Vatica Health | April 20, 2022 | Provider, Risk Adjustment, Value-Based Care

As efforts continue to improve quality and reduce healthcare costs in the U.S., evidence shows that racial and ethnic health disparities have a significant negative impact. According to a report from the Commonwealth Fund, “Black and American Indian/Alaska Native (AIAN) people live fewer years, on average, than white people.” They are more likely to die from treatable conditions, to die during or after pregnancy and suffer serious pregnancy-related complications, and to lose children in infancy. Black and AIAN populations are also at higher risk for many chronic health conditions, ranging from diabetes to hypertension. 

The harsh reality of these health disparities was revealed by the COVID-19 pandemic and its disproportionate impact on people of color. Black, Hispanic and Asian populations in the U.S. have significantly higher infection rates, hospitalization, and death compared to white populations.

The effect on the cost of healthcare is substantial. A recent Texas study showed that over the last six years, racial and ethnic health disparities in the state have resulted in $2.7 billion in excess medical spending and $5 billion in lost productivity.

An important step to reducing disparities is efficiently collecting race and ethnicity data. This has proven to be a difficult task due to:

The lack of standardized race and ethnicity categories
Incomplete forms used to collect the data
Electronic health records built without the ability to collect the information
Discomfort of healthcare staff asking for information
Few detailed descriptions for patients to accurately self-identify
Patients may be reluctant to share this kind of information

Additionally, social determinants of health (SDOH) have proven to be a significant source of disparity among racial and ethnic minorities. Using quality tools as a method for collecting data and advancing health equity has great potential to address the deeply rooted issues of SDOH. While some improvement has occurred, more work is needed.

National Committee for Quality Assurance Strategies

The National Committee for Quality Assurance (NCQA) compiles the Healthcare Effectiveness Data and Information Set (HEDIS). This provides quality results annually for more than 203 million people and 60 percent of the U.S. population.

NCQA introduced a racial/diversity measure in 2015. But health plans struggled to obtain the needed data through member self-reporting, disease registries and other traditional means. NCQA’s 2019 records showed that approximately 76 percent of racial data and 94 percent of ethnicity data were incomplete for the commercial product line. Medicare plans demonstrated higher collection rates: 26 percent of racial data and 60 percent of ethnicity data is incomplete.

The lack of completeness raised concerns about relying on traditional sources to accurately measure disparities in care. Without reliable data, identifying those with unmet needs is difficult.

Improving Data Collection

To increase collection of data from health plans, NCQA began requiring stratifications by race and ethnicity in 2021.

NCQA started with five measures across key known disparities: colorectal cancer screening, controlling blood pressure, hemoglobin A1c control for patients with diabetes, prenatal and postpartum care, and child and adolescent well care visits.

Race and ethnicity data on these measures help plans better understand member needs and provide services to address those needs. Plans can measure and track performance on disparities and implement data-driven approaches to close care gaps and improve outcomes in vulnerable communities, especially related to SDOH.

Some plans are already working to close equity gaps. Centene Corporation was recently awarded the Innovation Award for Health Equity by NCQA. They implemented a data-driven approach focused on community disparities within markets. Improvements were seen in colorectal cancer screening rates for American Indian/Alaska Native members, increased rates of immunizations for Latino children and better maternal outcomes among Black mothers.

Help is available to health plans seeking ways to reduce disparities of care among their membership. Vatica Health, for example, provides technology and dedicated clinicians to enable providers to efficiently capture more accurate and complete diagnostic coding and documentation for risk adjustment and improving quality of care. As part of this process, Vatica can collect race and ethnicity information using CDC specifications for the measures designated by NCQA. This helps Vatica clients meet NCQA requirements and collect the data needed to identify and reduce disparity gaps in care.

Conclusion

High quality, affordable healthcare for all isn’t possible without addressing disparities in our current system. Collecting race and ethnicity data is the first step toward developing effective solutions to address this complex challenge. While this is not a simple task, actions by NCQA and other stakeholders show potential. Collecting and using race and ethnicity data to identify disparities and factors that drive them is critical to achieving better healthcare for everyone.

About Vatica Health

Vatica Health deploys clinical nurses at the point of care, armed with powerful technology. Vatica’s solution accelerates the transformation to value-based care by helping providers, health plans, and patients work together to achieve better outcomes. Visit https://vaticahealth.com/ to learn more.

How to close care gaps for patients with SDOH

By Vatica Health | December 7, 2021 | Provider, Risk Adjustment, Value-Based Care

By Shannon Lukez, chief clinical operations officer, Vatica Health

Even before COVID-19, providers struggled to close care gaps. The pandemic has only worsened the problem as some patients continue to delay or forgo care out of fear of contracting the coronavirus. In addition, there’s a significant number of patients who struggle with non-medical factors such as lack of transportation, economic stability, literacy, housing, and food insecurity which contribute to untreated care gaps and poor outcomes. Unaddressed social determinants of health (SDOH) not only leads to disparate care, it also prevent providers from optimizing performance under value-based care (VBC) programs. Why is it so hard to close gaps in care – especially for patients with SDOH?

Provider burnout. For starters, addressing SDOH is one more thing—albeit a critically important one—on an already daunting to-do list. Many providers are on the verge of significant burnout, which is being exacerbated by a shortage of resources caused by Covid-19. When faced with the patient in front of them, they’re frequently only able to address the condition prompting the reason for the visit. They don’t have the time or staff necessary to dig more deeply into the non-medical factors that could be contributing to the patient’s overall health status.

Lack of SDOH data. Many providers don’t have the data necessary to identify at-risk patients. If they don’t collect this data themselves or have access to it in some other way, they won’t know which patients are facing SDOH-related challenges. It’s impossible to effectively address these barriers without having a targeted, analytics-driven approach.

Lack of clinical and administrative support. Providers don’t have the clinical and administrative staff necessary to perform patient outreach and engagement. Many practices are still struggling to retain staff needed to perform the most basic duties necessary to keep the business afloat. Recent Covid-19 vaccine mandates for healthcare workers have only worsened the resource constraints. Tackling SDOH is an added responsibility for which many providers feel their staff simply don’t have the bandwidth.

How health plan-sponsored programs can help

The good news is that some health plans are starting to step in and partner directly with primary care physicians to help them close care gaps and address SDOH. That’s because these payers realize providers can’t do it alone.

Consider BlueCross Blue Shield of Massachusetts (BCBS-MA) that has begun to incentivize providers to address gaps in care specifically for people of color. The payer is using existing HEDIS data to identify racial and ethnic disparities and then link solutions to its current value-based purchasing model.

As part of this initiative that will begin in 2023, BCBS-MA will work with providers and employers to collect data and continue to ask members to self-identify. BCBS-MA is also using imputed data (i.e., data that assumes a member’s race based on multiple factors). It will focus on colorectal screenings, adolescent well care, severe maternal morbidity, and antidepressant medication management for Asian, Black, and Hispanic members of its commercial plans that are already attributed to its primary care-focused Alternative Quality Contracts.

The BCBS-MA initiative is a step in the right direction because it acknowledges the importance of these two elements: Comprehensive SDOH data and aligning VBC care with financial incentives. However, health plans cannot overlook a third factor that’s equally as important: Infrastructure augmentation—specifically, clinical and administrative support.

A health-plan sponsored program can help incentivize physicians to identify and address SDOH without adding operational burden. However, this type of program must not only supply data, technology, and aligned financial incentives—it must also provide expertly-trained people and clinical resources to achieve and maintain physician engagement.

To learn more about Vatica’s PCP-centric solution to improve clinical and financial performance, visit https://vaticahealth.com/.

Why PCP-centric risk adjustment and quality programs help identify and address social determinants of health

By Vatica Health | May 27, 2021 | Provider, Risk Adjustment

The data might surprise you. Medical care accounts for only 10%-20% of the modifiable contributors to healthy outcomes. The other 80%-90% are referred to as social determinants of health (SDOH)—the conditions in the environments where people are born, grow, live, learn, work, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. Examples of social determinants include housing and economic stability, literacy skills, access to nutritious food and physical activity opportunities, and more.

By identifying and addressing SDOH, physicians—especially primary care physicians (PCP)—can aid in removing the barriers and challenges that impede a person’s healthy lifestyle, wellbeing, and ability to achieve positive health outcomes. Identifying and documenting SDOH not only helps drive actions to improve these conditions, but also positively impacts performance in value-based payment models such as accountable care organizations, patient-centered medical homes, and Medicare Shared Savings programs that reward providers based on health outcomes—not volume.

In addition, PCPs’ efforts to address social determinants counts toward medical-decision making under fee-for-service payment models. As these payment models continue to evolve, it becomes easier to justify whole-person, patient-centered care.

Taking a PCP-centric approach

PCPs are uniquely positioned to capture and address social determinants because they already have trusted relationships with their patients and can engage them on a personal level. They are also at the center of clinical care, public health, behavioral health, and community-based resources.

Every touchpoint with a patient presents an opportunity to identify, capture, and address these critical factors that impact health outcomes. Annual wellness visits, for example, are a perfect time to address SDOH. Seizing these opportunities is paramount because a patient’s social or economic status can change over time. For example, opportunities for good health can be constrained after a recent job loss; or a patient may move into an area that is considered a food desert, making healthy food options highly impractical.

The challenge: Operational limitations

Most PCPs know that social determinants play an important role in health outcomes, yet finding ways to identify and impact these determinants is a challenge. Most patients aren’t necessarily forthcoming with information. Even once identified, carving out time to engage patients in meaningful conversations can be daunting. Another challenge is identifying and addressing implicit bias that can thwart efforts to address SDOH. In addition, physicians must be able to connect patients community resources.

Given these obstacles, it’s not surprising that there are countless missed opportunities to address social determinants. This dynamic is exacerbated by PCP burnout and PCPs lacking the tools and resources to effectively address SDOH.

The solution: A health plan-sponsored, PCP-centric risk adjustment and quality programs

Over the last several years, health plans have shifted resources toward PCP-centric solutions, especially in the case of coding and quality programs. This represents an important trend for physicians, as legacy risk adjustment programs work around PCPs and prevent them from closing care gaps and addressing SDOH. Because PCPs have an existing and trusted relationship with their patients, such programs have much higher engagement than in-home risk assessments.

Another important development has centered around the recognition that technology alone doesn’t solve these problems. Infrastructure augmentation, especially support from licensed clinical consultants, is critical to helping busy PCPs develop a comprehensive view of the patient. This serves as a catalyst for an open discussion about possible social determinants of health that may be impacting their health and quality of life.

In addition, PCP-centric programs can offer guidance and support on establishing a team-based approach to screen for social determinants. For example, onsite RNs, LPNs, or PAs can ask patients about their social determinants while checking vital signs and alert PCPs when a deeper conversation about social determinants is warranted. Receptionists can distribute SDOH screenings tools upon check-in. Everyone within the practice plays a role of driving engagement and results.

Training is also critical. PCPs who undergo training to address implicit bias will be better equipped to have conversations about SDOH. PCPs must also be able to deliver strong, personalized messages about preferred community resources and follow up with patients to ensure they are getting the help they need. Training the entire team on implicit bias, health equity, and cultural proficiency is also a good idea.