A recent survey from Change Healthcare found that 80% of payers are currently incorporating interventions around the social determinants of health into their population health management initiatives. In fact, in March of 2018, a group of commercial payers and other healthcare organizations formed a coalition called Aligning for Health (AFH) to explore how addressing the social determinants of health can lower care costs and improve outcomes. Participating payers include the BlueCross BlueShield Association, CareSource, Humana, UPMC Health Plan, and WellCare. These organizations believe that addressing social factors, including access to healthy food, safe housing, and financial security can improve health outcomes, costs and utilization.

Two AFH payers leading the effort with innovative, community-based programs already delivering demonstrable results are BlueCross Blueshield and Humana.

BCBS Association Forms the Institute

Population health initiatives are increasingly looking to leverage community-based data that can help identify geographic and social determinants of health. While typically this data has been used to facilitate care coordination between hospitals and providers, payers are now looking to use this data to improve access to care for their beneficiaries. Serving one in three Americans in nearly every geographic region of the country, BCBS is one of these payers.

On March 14th, BCBS Association announced the creation of the Blue Cross Blue Shield Institute (BCBS Institute) to address the “zip code effect.” The zip code effect is where population health varies by neighborhood depending on access to adequate public transportation, grocery stores, medical centers, pharmacies and fitness facilities. The first-of-its-kind organization in scope and scale, the Blue Cross Blue Shield Institute (BCBS Institute) leverages neighborhood-level data to identify social determinants of health and bring strategic partners to the table to deliver tailored solutions.

Two of the social determinants their data identified as most influential to the health of their members, particularly for the cities of Pittsburgh and Chicago, was transportation and pharmacy deserts. Today, 3.6 million Americans have transportation issues that prevent them from getting to or from a doctor’s appointment, and 25% of lower-income patients have missed or rescheduled appointments due to lack of transportation. To solve this issue, BCBS Institute partnered with Lyft to make it possible to dispatch rides for patients located in transportation “deserts.” In doing so, patients with limited public transit are provided with reliable access to transportation for medical appointments, pharmacies for medications, and grocery stores for nutritious foods.

“Lyft is proud to partner with the Blue Cross Blue Shield Association to address the social determinants of health through the launch of their new Institute,” said John Zimmer, Lyft co-founder and president. “The work we’re doing with BCBSA is critical to our goal of reducing the transportation health care gap by 50 percent in the next two years—and a key part of our mission to improve people’s lives with the world’s best transportation.”

More recently, BCBS has partnered with CVS Health and Walgreens to address pharmacy access. Over the past several months, BCBS has been testing a pharmacy rides program at select Walgreens locations in Chicago and select CVS locations in Pittsburg. CVS funds Lyft rides to pharmacies for Blue Cross customers in Pittsburgh living within select “transportation deserts,” and in Chicago, Walgreens pays for Lyft rides for members located far from public transportation. By uniting localized beneficiary data with Lyft’s services, the Institute was able to integrate an innovate service into their care delivery model that is working to improve treatment adherence. Patients in both cities will also be able to get rides to their primary care doctors later in the year in an effort to reduce appointment no-shows. The BCBS Institute will be monitoring prescription pickup and appointment attendance rates as the metrics of program effectiveness.

Humana Launches Bold Goal Initiative 

Several years ago, Humana launched the Bold Gold Initiative, a population health strategy to help the Medicare communities they serve be 20% healthier by 2020 by making it easier for seniors to achieve their best health. Bold Goal communities include Louisville, Baton Rouge (LA), New Orleans (LA), Broward County (Florida), Knoxville (TN), Tampa Bay (FL), and Jacksonville (FL).

Some of the social determinants of health Humana is focusing on include food insecurity, loneliness/social isolation, housing instability, limited English proficiency and inadequate emotional support.  Humana is addressing these social determinants through pilot programs and interventions with community and physician partners. For example, through partnership with nonprofit organization, Feeding America, Humana has developed and delivered resource toolkits to physicians that educate them on food insecurity and how to screen and treat it in their patient populations. Humana is also leveraging the U.S. Centers for Disease Control and Prevention’s “Healthy Days” tool to track Bold Goal progress.  The tool surveys individual’s overall mental and physical health over a thirty day period while also allowing them to see how they compare to others, access community resources, and share their healthy days by using #MoreHealthyDays. Bold Goal program performance is measured by an increase in members’ “Healthy Days.”

The recently released Bold Goal 2018 Progress Report reveals that implementing community-level changes has led to positive health outcomes for elderly beneficiaries with diabetes, heart disease, respiratory conditions, mental health issues, and other chronic diseases. A specific example of this is in San Antonia. Humana found that food insecurity, poor nutrition, and poor health literacy for elderly beneficiaries exacerbated the prevalence of diabetes and behavioral health issues in the community. In 2014, more than 11%  of patients in the San Antonio metro area had diabetes, compared to the national average of 9.7 percent. In response, the payer worked with stakeholders, including community health groups affiliated with the American Diabetes Association, to develop programs that address food insecurity and health literacy. The programs included a free diabetes resource guide to educate members on personal wellness, an interactive website that aids patients and physicians in selecting the most appropriate diabetes program, a partnership between San Antonio food bank and MCCI Medical group to create food distribution sites within MCCI’s community activity centers , and YMCA educational programs.

Since the launch of these pilot programs, Humana members in the San Antonio Bold Goal Community experienced a 3.5% improvement in the number of reported Healthy Days and reported unhealthy days decreased by 9%.

Conclusion

From extensive housing pilots to limit the influence of homelessness on hospital costs to food security programs that provide nutritional meals to low-income beneficiaries, payers are implementing widespread programs to take action against SDOH.

Examples like the BlueCross BlueShield Institute and Humana Bold Goals evidence that effectively tackling SDOH requires a deep understanding of social, behavioral and environmental factors at the zip code level, placing access to localized data at the center of any SDOH initiative. Data should be used to direct funding support and segment SDOH needs at hyper-localized levels. Secondary to data analysis comes the ability to form collaborative, long-term partnerships with community stakeholders who understand the unique characteristics of the community. It also depends on forming partnerships with organizations who can expand, innovate and improve access to available resources and services—from digital tech startups to national non-profits and chain retailers. As seen with Humana, it’s all about scaling payer-community partnerships to create a holistic healthcare experience for vulnerable beneficiaries.

As social determinant data becomes more widely available and interventions become more focused, even better results are expected to be seen in the future that will not only change the way payers engage with members and providers, but change the dynamic of social inequalities altogether.