Identifying the Need is Critical to Meeting It

Population Health News

Need for follow up on the data surrounding social factors that impact health

In an era when many in health care feel like they are drowning in data, it is important to recognize that data collection on social factors that influence health may be the only thing that will ultimately improve health outcomes.
Research has shown that medical care accounts for about 20 percent of health outcomes. Life style (diet and exercise), environmental and social factors account for the rest. Among the social factors that impact health are poverty, education, housing and food security. Yet, government-funded health plans aren’t allowed to use their funding for food or housing. If it can be demonstrated that providing food and housing will help to lower overall medical costs, maybe legislators at all levels of government will reconsider funding restrictions and rate setting methodologies.

As the Chief Medical Officer of L.A. Care Health Plan, the largest publicly-operated health plan in the country, covering mostly Medicaid beneficiaries, I know that data is a critical to demonstrate cost effective interventions that outcomes that improve health outcomes.

L.A. Care is supporting the California Food is Medicine Pilot which expects to show that medically-tailored meals can improve health outcomes of those with chronic illness. Since the program launched about a year and a half ago, targeting patients newly diagnosed with congestive heart failure with a recent hospital discharge, the pilot group in Los Angeles County has seen 30-day hospital readmission rates drop by about nine percent for those in the program. If the numbers continue to improve across the statewide pilot, it will further compel the state and federal government to consider adding medically tailored meals as covered benefits for Medicaid beneficiaries.

Social determinants of health data are also being collected across various departments within our health plan to aid our Population Health Management program. Care managers and social workers ask members about food security, housing or other needs, and depending on eligibility, direct them to available services.

The health plan also employs data analytic tools that utilize publicly available data, such as educational attainment, spending patterns and other things which could indicate how a member is living. We also use a community resource platform that’s available to our staff and our members to search and find resources in their community to assist them find the help they need.

Data available at the individual and the population level enables our clinical and social service teams to be aware of additional factors, such as social isolation or a member’s propensity to engage. Care managers and social workers can then respond accordingly.

Without access to clinical and demographic data, it can be difficult to identify member needs and connect them to services in a timely manner. Health plans that have the capability can analyze data, and in some cases respond. More social factors that impact health could be addressed if the solutions, like medically-tailored food, were a covered benefit.

The United States spends much less on social services and more on medical care than most other developed nations. It is less costly to address social determinants than it is to address health care for those whose social needs were not addressed. It’s almost as though government-funded health plans are suffering from a penny wise, pound foolish public policy.

We and others are gladly collecting the data to illustrate the success of programs and policies that address social determinants of health and improve health outcomes. We just need those holding the purse-strings to pay attention.