Considerations for Success in Addressing Social Determinants of Health at the Individual Level

Analytics, Health Equity & Access

  • Analytics

    Examine how healthcare data can provide insight across claims, cost, clinical, and more.
  • Health Equity & Access

    Creating an environment where everyone has a fair and just opportunity to be as healthy as possible.

Considerations for Success in Addressing Social Determinants of Health at the Individual Level

October 26, 2018

Social Determinants of Health (SDOH) are the conditions in which people are born, work, live, and age. The healthcare industry increasingly recognizes that improvements in health and health equity will only be possible after addressing SDOH, including socioeconomic status, education, neighborhood and physical environment, social support networks, and access to healthcare. Currently, payers use ZIP code characteristics to determine investments at the neighborhood level. The approach does not consider customized resource allocation at the individual level unless the member/patient has had multiple, high-cost interactions with the healthcare system (i.e., “hotspotting”).

UnitedHealthcare (UHC) is piloting a more targeted approach to addressing SDOH and will be tracking the results of the pilot work closely.

The steps of the pilot are:

  1. Identify “at-risk” members/patients using specific ICD-10 codes, CPT codes, and LOINC codes on claims
  2. Have care managers perform direct outreach to conduct assessments to evaluate specific needs
  3. Generate/update care plans that treats the entire patient, including social, medical, and behavioral services to address member-specific needs
  4. Connect members/patients to other payers, such as Medicare and Medicaid, if appropriate
  5. Enroll members/patients into relevant UHC programs, such as literacy programs or programs around self-care
  6. Arrange follow up
  7. Go back to step 3

These Considerations for Success were discussed as part of eHealth Initiative’s September 2018 Value & Reimbursement Workgroup meeting as presented by Anupam Goel, Chief Health Information Officer, Clinical Services, UnitedHealthcare.