Winning Together: How Health Plans Can Take a Collaborative Approach to Address SDOH

In today’s rapidly evolving society, there is a growing recognition that our health is intricately linked to various social factors, or health-related social needs (HSRNs), that are driven by social drivers of health (SDOH) such as the neighborhoods we live in, our economic stability, education levels, access to essential resources and others. SDOH often impacts certain communities more than others due to inequitable policies, infrastructure, and built and natural environments, leading to poorer health outcomes and more significant disparities across certain populations. SDOH’s impact on healthcare access and utilization can be considerable – even impacting the quality of care received, the affordability of services, and the overall healthcare journey one experiences. Furthermore, the impact that HRSNs have on our health and well-being, including stress, anxiety, and overall mental health, is equally significant. 

Managed care organizations (MCO), in particular, need to understand these community-specific factors to serve their populations effectively. Understanding lived experiences with healthcare access and use can help MCOs enact tailored programs and policies to support appropriate healthcare utilization. Through this work, the MCO serves members by engaging and listening to them while taking steps to foster the trust needed to best support them. Seeking to understand the unique challenges and barriers that a community faces can better equip the MCO to address SDOH. Many MCOs utilize state and federal funding that incentivizes SDOH efforts and encourages partnerships. The most successful MCOs embrace addressing SDOH and HRSNs as a “team sport” and foster partnerships and collaborations with local community-based organizations (CBOs) and agencies to tackle the challenges together. Through this collaboration, they engage community members in listening, learning, and addressing their unmet HRSNs. Including CBOs in this work is critical as they often have the trusted relationships with community members that many MCOs seek to build. Dr. Buckley explained, "[staff at] CBOs are often the people who are closer to the problems that patients have and hear those stories in a more crystallized way. They understand not just the person's physical health but also their social connection to the community, their wellness, and their financial health. Those are some really deep insights that can help healthcare organizations think about their interventions in more unique ways. CBOs can also help facilitate and drive some of those upstream forms of care." Ultimately, this work can go far in reducing health disparities and achieving the critical goal of advancing health equity. 

Centers for Medicare and Medicaid Services (CMS) recently released an updated ‘Framework for Health Equity’ to guide national efforts in reducing health disparities and promoting health equity. In alignment with the framework’s five priority areas, Activate Care supports MCOs in reaching this health equity North Star through the collaborative Community Health Equity Projects (CHEP). The mission of the CHEP work is to meaningfully engage community members to explore the state of equity of care, listen to the unique barriers and challenges communities experience, map available resources and service gaps, and identify community-driven solutions to address critical SDOH barriers that impact people's health and quality of life. Ultimately, this work helps MCOs better understand their communities and facilitates networking and collaboration with CBOs to combine resources to tackle the challenges identified. Consequently, they win as a team. 

Hearing directly from those with lived experiences is essential to advancing health equity, as the insights and perspectives garnered can inform more effective programs and policies that will support those who need it most. For example, through hearing diverse experiences and barriers to using non-emergency medical transportation (NEMT) services, health plans can refine their NEMT services accordingly to improve access and use of this service.  As one stakeholder from a prior CHEP project expressed: “I think one of the mistakes we often make is that we assume that we know what communities need, and sometimes we will insert a strategy or a project that has great intentions but may not be exactly what that local community needs.“ Hearing from many different people also sheds light on the diversity of opinions and thoughts – reinforcing that there is often not a “one size fits all” solution, and a tailored approach is often required. Too often, many voices are neglected, and programs and policies fail to produce the results they set forth to achieve because decisions are based on assumptions. That is not only a waste of time, money, and other resources but can also foster distrust and cause harm.

Our comprehensive CHEP process includes engaging hundreds of diverse community members with different social and health-related experiences, perspectives, and ideas for a better, healthier community. In collaboration with our customers, a multidisciplinary team of public health researchers, data scientists, and health plan strategists from Activate Care use a community-based, participatory approach at every level to integrate their voices in the design, delivery, and analysis. For example, we formulate a Community Advisory Council at the start of the project, inviting diverse community stakeholders to participate. This council helps ensure that our data collection tools are tailored to the unique communities we are engaging in, our approach and methodology are inclusive, far-reaching, and appropriate for the community, and our data analyses and interpretations align with community sentiment and experiences. Additionally, we partner with local establishments such as churches, nonprofits, and community health clinics to recruit and host focus group participants. We conduct individual stakeholder interviews with those who work in the community to address health and social needs, and we disseminate a tailored, community-wide health survey in multiple languages to ensure a diverse sample of participants. Furthermore, we remove participation barriers and offer flexibility around scheduling, transportation, and childcare to foster inclusivity and broader participation – all to advance health equity. 

Ultimately, the Community Health Equity Project supports health plans in several ways. By engaging health plan members to better understand their unique challenges and barriers to addressing health and social needs, their utilization of health plan benefits, community-based service and resource gaps, and other factors that are impacting their health, we provide community-informed, detailed insights and tailored strategic recommendations to health plans in areas that directly benefit their member population through improved offerings and programs. Through this process, we can increase member satisfaction and member engagement with benefits, boost health literacy, foster community partnerships to streamline access to and coordination of care, increase health plan recognition, and ultimately, improve quality scores and health outcomes for their members. “Nothing about us, without us” rings so true in the CHEP work. Our process to meaningfully engage the community members, stakeholders, and different sectors on multiple levels reflects the “team sport” spirit to improve health and well-being. With a structured process and emphasis on collaboration and engagement, health plans can achieve their aims around health equity and significantly improve the health and well-being of the communities they serve.

Interested in learning more about our Community Health Equity Projects? Click here.