Chief Executive Officer of Alliance for Better Health.
Even having just taken office, President Joe Biden is already making Covid-19 a top priority. And for good reason: We are more than nine months into a pandemic that has infected nearly 25 million and killed over 400,000 in the United States. Behind the numbers are people of all ages and incomes, but the impact is greatest in communities of color, particularly those who don’t have access to healthy food, affordable housing or other contributors to optimal health.
In response, the Biden campaign announced policy recommendations in July that include ways to address social determinants of health (SDoH) directly by leveraging data, investing more in community health care workers, and targeting hunger and homelessness. The President has also committed to broadening the Affordable Care Act by offering expanded Medicaid, introducing a new public health insurance option and increasing funding to underserved communities to address health disparities.
While these changes will help, it will take more than funding and access to address SDoH in the long term. The Biden administration needs to carry out policies that change how health plans, hospitals and community-based organizations work together to improve health. These policies should flow from guiding principles: new financial incentives that align with (rather than compete with) better health and the use of technology to improve efficiency, effectiveness and accountability.
Why Today’s Efforts Aren’t Set Up For Success
Between 2017 and 2019, investments in SDoH programs totaled $2.5 billion, and that figure will likely increase in the wake of Covid-19. Over the last few months, we’ve seen an increase in partnerships between medical care providers, local governments and community organizations collaborating to address gaps in social care directly related to the pandemic.
But research shows that these initiatives often fail long term for a few key reasons:
• The initiatives exist in silos, creating gaps through which humans fall.
• Demonstrating return on investment can take years.
• Technology is underused and, in many cases, lacks interoperability.
A more effective approach will reward quality rather than quantity by incentivizing health plans to work with a network of community-based organizations (CBOs), as well as hospital systems and local governments. Also necessary is a digital infrastructure that can easily connect individuals, CBOs and health plans so that the right thing to do is the easy thing to do and the system captures data along the way, helping us demonstrate the value of this network as it grows.
Our company has already seen success here in the Capital Region of New York. With the help of Unite Us, our closed-loop referral platform, we have empowered health plans, CBOs and medical providers to connect individuals in the community who have social needs to the right services like food banks and homeless shelters. In one assessment of the platform’s effectiveness, we reviewed data for a sample of 1,000 community members and compared their ED visits from six months before and six months after they were connected to services using our referral network. We found that ED visits decreased by 16% after they were connected to services — saving about $350,000.
Where The Biden Administration Can Step In To Scale Social Care
Programs like this exist in pockets across the country, but we are still far from true health equity. It will take the federal government’s leadership for these efforts to become more widespread and successful. Let’s focus on both the problems to solve and the levers that government has to solve them.
1. Redundant solutions and a lack of interoperability between many health IT solutions are holding back progress. Since we think of health care as the sum of medical care, social care and behavioral health care, the technology used by all these sectors is health information technology — which puts it in scope for the work of the division of the U.S. Department of Health and Human Services where I once served as deputy director: the Office of the National Coordinator for Health Information Technology (ONC).
ONC’s regulations and guidance provide a framework that other federal entities invoke to create incentives for alignment with technical standards. For example, CMS invoked ONC regulations in the definition of the meaningful use of certified health IT for which hospitals and eligible providers were given incentive payments. In a similar manner, ONC can define interoperability requirements for the “payloads” of referrals to and from medical, behavioral health and social care providers.
In order to receive federal funds (Medicaid payments as well as nutrition or housing grants), agencies such as HUD and USDA can require CBOs and others to use technology that meets ONC’s interoperability standards.
2. Community networks. The federal government should create a national public-private nonprofit to converge regional networks so that operational redundancy within regions is eliminated. Too often, the silos of well-intentioned narrow networks cause confusion and waste in the domain of social care.
With better technology and unified regional networks, we’ll have the ability to move away from a fee-for-service model and toward something like a per-member-per-month payment model (PMPM) that prioritizes (and rewards) health rather than care. The ultimate goal of these initiatives will be to reimagine social care providers as parts of regional public utilities that everyone pays into and, in turn, reaps the benefits of.
Imagine how we can elevate the health of our communities by addressing the social factors that account for certain health outcomes. By making these changes today, we’ll emerge from the pandemic with the beginnings of a new framework to advance population health.
Forbes Technology Council is an invitation-only community for world-class CIOs, CTOs and technology executives. Do I qualify?