Roadmaps for Implementing and Sustaining SDoH Programs

Published on July 29, 2019

When Carrot Health CEO Kurt Waltenbaugh attended the RISE Health National Summit on Social Determinants of Health in Washington D.C., he delivered a Power Breakfast Series talk on implementing successful, scalable #SDoH programs. While he was there, he had the opportunity to talk with payers, providers and policy makers and to attend several panels. This is the second of three blog posts with highlights from that experience. You can read Part 1, a summary of the Summit’s key themes, here.

By Kurt Waltenbaugh

At the recent SDoH summit hosted by RISE Health, industry leaders described actions we can take now to impact SDoH and health outcomes in the U.S. Here are lessons from three sessions that offered roadmaps for implementing and sustaining SDoH programs.

Creating and Securing a Sustainable Financial Model for SDoH

An insightful panel presented by McKinsey’s Erica Hutchins, The Commonwealth Fund’s Melinda Abrams, and Centene’s Michael Monson summed up the industry frustration with lack of progress:  Why does everything start & end with a pilot? There is tremendous demand from healthcare. There are countless organizations supplying the needed services, yet there are very few payments flowing beyond pilots. Why is this supply not able to scale to meet the need? What causes this market failure?

Most remarkable is that much of the work historically has been provided for free by mission-driven, philanthropic organizations, creating a free-rider and tragedy of the commons scenario. In addition, there are three underlining issues:

  1. Culture – Deep linguistic and cultural differences between the established “health” industry (payers and providers) and the “social” support industry (community benefit organizations, i.e. CBOs). We speak different languages and have different values.
  2. Fragmentation – The social sector has many, many small groups of people each trying to support a wide variety of payers. This prevents healthcare from payer social supports based on the value they generate. There is far too much overhead for administration.
  3. Standardization – There is not a standard product being offered. Each social support entity has its own unique way of delivering. This is anathema to a health industry ruled by ICD10 codes.

Centene is trying to bridge this gap by creating a “Social Health Bridge” as a financial and interventional industry mediator between the supply and demand. Its goal is to sign up all like social services in a community, standardize the product, and contract (at-risk) with the appropriate healthcare entities.

The key insight from this panel? To succeed in sustaining SDoH programs, we must align with a person and their needs. Not a payer. Not a provider. Not a CBO. And most certainly, not a population. Identify a person and a need. Solve it, and then tie it to an outcome.

Designing your SDoH Roadmap

Leavitt Partners’ Cristal Gary, HCSC – BCSC of Illinois’ Jenné Johns, and Greater Chicago Food Depository’s Nicole Robinson described how the landscape is ripe for change:

  • economic (aging demographics costing more to support)
  • political (#1 issue for voters in the 2018 election; 2020 shaping up to be similar) and
  • moral (the system is not working for every larger numbers of people)

Designing an effective roadmap requires an understanding of

  • the population (what do they actually need?)
  • intervention opportunities (what can we do today?) and
  • community partners (do they have the capacity to handle the volume we send them?)

Community partners also have unique capabilities that may not be apparent on the surface. For example, a food repository may have access to screen consumers about their broader social and behavioral needs. The food repository staff can be allowed into the home in a way other entities may not. The food benefit is often valued to the point where contact information is updated and more accurate via the food repository than what is shared with the payer or provider.

The lesson? Coordinate with your partners when working toward sustaining SDoH programs!

Beyond the Buzz: Disciplined Roadmap for Implementing Successful, Scalable SDoH Programs

I also presented a road map for sustaining SDoH programs. During my session I provided examples demonstrating how to use consumer data to identify needs across the community and to justify the investment to create an intervention.

Key lessons:

  • Start with what we can measure. Measurable equals fundable.
  • Don’t boil the ocean. Pick something valuable enough to get attention but small enough to be possible.
  • Narrow your focus. Target a subset that (a) has the need and (b) is willing to engage.
  • Carefully define and agree on how to measure health outcomes.
  • One size does not fit all. Each individual has a unique fingerprint of risk that must be taken into account for the intervention to succeed.

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