The Medicare Shared Savings Program (MSSP) launched in 2012 and has since grown from 27 ACOs to now 561 covering around 10.5 million beneficiaries in 2018. In August...
At the RISE National conference, Activate Care's Matt Goudreau hosted a roundtable discussion to explore: What barriers prevent you from providing proactive SDoH interventions?
The roundtable sparked engaging conversations with leaders from organizations like Humana, Health Choice Utah, Change Healthcare, Optum, AmeriHealth Caritas, among others from across the country. The first major set of barriers discussed centered around screening for needs- is it done, when and by whom, and what to do with the data once screens are complete. The four main takeaways were:
- Screening is avoided because organizations don’t have the resources to address the risks they would uncover. In this scenario, primary care providers recognize that if they identify SDOH needs in their patients, it can be worse if they don’t have a solution to address it.
- Screening is avoided because it’s not viewed as a priority. Most clinicians say screening does not happen because there is always something more immediate and “higher risk” to focus on addressing. So, unless a patient asks for help, underlying needs will not be addressed.
- In many areas, screening is occurring, but systems are struggling to deal with the volume of interventions needed. Organizations that do perform screenings uncover such a high number of patients who require interventions that it becomes difficult to manage. Without a system to track and provide support, it can seem impossible to properly address and manage high volumes of patients.
- Screening has reasonable success but systems do not have a singular dataset to prove their interventions are effective and save money. It’s a common theme that organizations are only able to track end-to-end data on a portion of the journey, not the entire journey due to a lack of a centralized community care record. For example, a person with four needs may have two that are handled directly by a CBO and tracked in their system; one that goes unaddressed, and one completed through a referral technology. This creates a scenario where the data about meeting those four needs for a single person lives in multiple silos and the whole story of their care journey isn’t getting told.
It became clear during the discussion that data is needed to prove that the effort to screen and act is worth the investment and can be extremely useful in motivating change. So, we asked a follow-up question to the participants in this roundtable:
"How do you collect data for an ROI story?"
A lot of insurers agree that it’s challenging to relate claims data around SDOH work, because of the lack of tracking what’s done and what isn’t done. A complete data set is key to proving that doing the work to proactively address SDOH has a positive impact. This is why having everything in one space to tell the entire story is a game-changer because it shows that the work being done is financially impactful to the bottom line.
Now that we have a complete picture of the barriers organizations face, we asked our participants what they'd look for to address these barriers. We learned two main things from this question:
- Organizations have insights into who needs help and what needs to be done, but they need a solution to create action on these insights.
- When it comes to measuring impact and effectiveness, there is a lack of a complete data set to analyze which could be leading to potential inaccurate and costly assumptions being used in their analysis.
This roundtable discussion confirms that complete data sets and proof of the impact of SDOH work is vital to driving successful proactive SDOH interventions. We must steer away from traditional, reactive approaches that fall short and leave individuals with poor health outcomes, and payers with high cost and utilization. Activate Care’s newest offering Path Assist is an intervention model that shifts from the reactionary referral-based paradigm to a proactive, whole person care approach. Click the link to learn about how managed care organizations, state and county health departments, and at-risk providers can screen populations for SDOH needs proactively and deploy a workforce of trained Community Health Navigators to guide each member to and through the right care, every time.