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How Payers Are Addressing Social Determinants During Pandemic

The first step in addressing social determinants of health (SDOH)—identifying and capturing information—is challenging for many payers. Partially because patients may be hesitant to disclose information on their housing or employment situation if they even think about mentioning it in the first place when accessing medical care. Additionally, providers may not be trained to ask questions, or are unsure asking about social needs they don’t have resources to address fully.

Yet, challenges such as homelessness, food insecurity, lack of transportation, unstable income, and more can have a significant impact on an individual’s physical and mental wellbeing. Social determinants account for 80-90 percent of a patient’s health outcomes, and the COVID-19 pandemic only exacerbates these needs.

Socioeconomic barriers can also lead to an increase in emergency utilization and unnecessary admissions. For payers, addressing SDOH can not only keep care costs down but also improve member outcomes.

Steps Payers Are Taking During COVID-19

HealthPayerIntelligence.com reported six ways that payers are adapting strategies for addressing SDOH to factor in the COVID-19 pandemic:

  • Expanding access to telehealth
  • Addressing food insecurity 
  • Providing transportation or meeting members where they are
  • Finding housing options
  • Providing employment resources
  • Identifying populations at risk for COVID-19

In Becker’s Hospital Review, Presbyterian Healthcare Services—an integrated system of hospitals, providers, and payers—shared how it was able to use many of the above strategies to ensure members and patients had their needs met.

In the early days of the pandemic, Presbyterian was able to identify more than 20,000 of its most vulnerable health plan members and begin outreach. Additionally, Presbyterian was able to quickly identify which members had positive COVID-19 test results along with unmet social needs that may hinder their ability to successfully and safely recover. Staff was able to reach out and ensure each member had a two-week supply of meals—ensuring they were able to stay home to recover while mitigating the unnecessary spread of the infection, and without worrying about where their next meal was coming from.

Enabling patients to receive appropriate follow-up care while balancing the strain on resources was also critical. Presbyterian developed a remote monitoring program for those diagnosed with COVID-19, and case managers ensured each member had the necessary resources to utilize telemedicine effectively.

Ultimately, data can help payers not only identify vulnerable, at-risk member populations, but also seamlessly collaborate with all of the community-based resources needed to address social determinants of health fully. The flow of information has become even more useful with increased uncertainty and risks.

Brittany Eastman
Content Marketing Specialist