Full Lifecycle Interventions for Addressing Social Determinants of Health

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Full Lifecycle Interventions for Addressing Social Determinants of Health


Thomas H. Lee, MD, MSc, interviews Praveen Thadani, MPH, MHA, President of Priority Health.

Tom Lee:

This is Tom Lee, Editor-in-Chief for NEJM Catalyst. Today, we’re talking with Praveen Thadani, President of Priority Health, which I think of as one of the most innovative health plans in the country.

It’s part of Spectrum Health, the integrated delivery system in western Michigan. We’re focusing on cutting-edge work that Priority Health is doing in social determinants of health (SDOH). Priority Health was already on many of our radar screens because, when Covid-19 hit, they developed a virtual-first product; they’ll soon be updating NEJM Catalyst readers for the progress report on that.

Today, we’re talking about another important area in which Priority Health is taking an array of actions: addressing health equity and the social determinants of health that drive so many of our patients’ medical problems.

Praveen, we can safely assume that most of our audience knows about the importance of social determinants of health, but not all of them know much about Priority Health. Can you give them a quick 1- or 2-minute description of your plan?

Praveen Thadani:

Absolutely, Tom, and thank you for giving me this opportunity to talk more about social determinants of health. Before I dive in and do a quick 1-minute update of our plan, very quickly, we are fortunate to be integrating with Beaumont Health effective February 1, so we are temporarily, instead of Spectrum Health, calling ourselves BHSH System. Some great news on that front.

Let me dive in. We are the largest nonprofit health care plan in Michigan. Our commitment has and always will be to our members and the communities we serve. We recognize the vital role we play in addressing social determinants and working to achieve health equity.

Today, our team proudly serves more than 1.2 million members, and we offer extensive benefit options for not only employer groups, but also individuals, including Medicare and Medicaid and Obamacare, or ACA (the Affordable Care Act).

We are continuously recognized as a leader for quality, customer service, pricing transparency, and product innovation. A few things that set us apart: One is our low administrative cost. We spend nearly 90 cents of every dollar on member care, and only use about 10 cents for necessary administrative costs.

We were among the first health plans to offer members a pricing-comparison tool or cost estimator, a highly used tool that brings more value to our members and all our purchasers. And it’s recently been reported on, as you mentioned earlier, that we were the first insurer in the country to launch virtual-first health plans in the individual market in 2020,1,2 which have done exceptionally well for us.

Lastly, we create innovative value-based care incentives and programs with our provider network that help identify and address social determinants of health, which we can talk more about in a bit.

Lee:

Thanks so much. As I said, we won’t take time to recap how important SDOH are, but instead focus on what Priority Health is doing about them. I would emphasize them because SDOH is not one thing for which a single initiative is enough.

How should organizations organize themselves for this work? Your team breaks them down into five key categories, right?

Thadani:

That’s correct, and Tom, before I respond to the question, let me articulate my background. I have a Master in Public Health focused on disease prevention and health promotion. One of the important things, which I know all our listeners already realize, is that the vast majority of health outcomes, disparities as well as health outcomes in general, are determined by social determinants. Social determinants could be [responsible for] potentially up to 80% of health outcomes.3 This is a very important topic for our organization.

One of the first steps in organizing yourself is to ensure you are making this work a priority, and we have here at Priority Health. Addressing social determinants or achieving health equity is not something that can be done off the side of our desk. We need purposeful engagement from your team and to allow for teams to have bandwidth to focus on this work. We’ve done exactly that. We have dedicated staff, but most importantly, this is a committee that reports directly up to our board, as well.

As far as categorizing social determinants, we typically use subsets established by the U.S. Department of Health and Human Services in [its] Healthy People 2030 objectives.4 That includes five categories: (1) education, access, and quality; (2) neighborhood and physical environment, which means the physical environment where people live; (3) economic stability; (4) community and social context, and in there, we primarily are referring to [relationships with family, friends, colleagues, and community members]; and (5) health care access and quality — and that’s where Priority Health comes in.

We recognize that we have a responsibility to ensure access to health care; several studies have shown that health care access is a major barrier to achieving high-quality health. When we’re looking at interventions that will address the previously mentioned categories, we break things down at three levels: (1) the individual level, [like] social needs and individual member pain points, which we’ve got to address; (2) the community level, which is the more high-level social determinants of health; and (3) the society level, which digs deeper into the structural determinants of health equity. That’s how we tend to orient ourselves and think about it.

Lee:

Even breaking them down as you have, these problems are so huge, I can easily imagine the phrase “boiling the ocean” coming up when you discuss taking them on. How does Priority Health break down the work?

Thadani:

Great question, and I completely agree. Like you mentioned, these are significant issues and ones that are systemic, sometimes far-reaching, and deeply ingrained in our society. Change is certainly not going to happen overnight, but with commitment from dedicated organizations, we can begin to make an impact one step at a time.

To break down the work, we first don’t look at addressing social determinants as just an area of business, but as our responsibility. It is our responsibility to invest in programs that will directly address the critical social determinants that adversely affect the health and well-being of our members.

A few steps we took initially to get started in this work: First, we assessed our membership to ensure that our products are reaching an audience reflective of the populations we serve. And then, having all our team members complete an implicit bias training, which is an eye-opening experience for many of our team members.

One important thing I want to note is that effectively partnering with the provider community is key to this work. We create unique value-based programs and incentives for our providers that directly align with our work to address social determinants.

Two quick examples of this: We were the first insurer in Michigan to offer financial incentives to providers who capture and track patient data related to social determinants. There are codes available for that. We call them Z codes, and we incent our providers to record those Z codes. [Second], we were the first insurer in Michigan to support the CenteringPregnancy model of care through provider incentives. This is a mode of group prenatal care that helps reduce preterm births and increase companionship during pregnancy.

Last summer, we announced our new “full lifecycle” social determinants initiative.5 This first-of-its-kind program will enable Priority Health to proactively identify social risk among our members, initiate culturally resonant engagement, connect people with critical resources to address their needs, and repeatedly measure the impact to refine our future programs.

We partnered with industry leaders Socially Determined, ConsejoSano, and Aunt Bertha to create this data-driven, full lifecycle approach for addressing social determinants and improving health outcomes.

While I’d say it’s one thing to understand that a social factor is impacting someone’s health, we wanted to go a step further and create a program that directly addressed members’ needs. That’s the reason why we launched the first full lifecycle social determinants initiative.

Lee:

We’re talking about a series of interventions, not just one, if I have it right. You described some of them. Are there others that you’d like to give us a little taste for?

Thadani:

You’re right. It’s a series of interventions. Making sure our members have access to the care they need isn’t enough. Our goal in this process is to address all the factors that affect our health, not just at the doctor’s office or in the hospital, but also through access to healthy food, secure, reliable transportation to health care facilities, and everything in between.

Let me offer three specific examples. I mentioned transportation. Priority Health organizes transportation for Medicaid members who need a ride to medical appointments or to pick up medicine and other health care supplies.

We coordinate all of this in house. Our members will work directly with a Priority Health employee to coordinate their ride service. This has been a successful program for us, and we’re going to continue looking at the possibilities around transportation beyond our Medicaid members.

Another good example is what we call Priority Health Connect. This is a complementary online platform designed to connect individuals in the community with free and reduced-cost programs and critical social services. We get a lot of data around what their need is. We connect them with the services, and they can search for these services by using their zip code. It’s really a neat service.

The third great example, one that excites me tremendously, especially as my parents are Medicare Advantage recipients and often deal with social isolation, is a partnership we have with an organization called Papa. This program connects Papa Pals with eligible Medicare Advantage members who need assistance with transportation, household chores, basic technology lessons — how do I use my iPad, as an example — or even basic companionship and other senior services.

Lee:

These are great programs. What’s the data infrastructure you’ve had to develop to support this work?

Thadani:

Great question, Tom. As you can imagine, data is the lifeblood of enabling a program like this. We do have a full-time data and analytics team dedicated to this work.

As part of our full lifecycle social determinants of health program, a couple of things. One, we are measuring risk exposure and impact likelihood at both the neighborhood and individual level. This allows us to understand and address individual barriers to optimal health, and at the same time, identify systemic issues and resource gaps impacting specific communities. Having that data enables us to link them to the right services, in essence.

Two, together these views will allow us to broadly leverage the social determinants data across all our services, ranging from onboarding new members to chronic condition care management to determining investment in community resource partnerships. Data is the lifeblood of what we’ve got to do. It arms our decision-making around what interventions, with whom, in what community, where we invest our community impact dollars, and ultimately, thinking about optimizing our care management programs.

Lee:

How will you know how it’s going? Whether or not you’re having an impact?

Thadani:

Our ability to objectively measure outcomes is critical because this is such a new and emerging area, so we certainly thought that through.

Our partnership with Socially Determined will allow us to measure impact in a standardized and repeatable way to iterate and apply new insights back into the lifecycle. This will help drive our decisions around future community investments and social services collaborations. So, a lot of data that we’re getting through our partnership with Socially Determined.

We desire to be guided by data, and success to us is providing more personalized support for each member and meeting their unique needs when they need it most.

Creating heath equity in our communities will lead to members living happier and healthier lives, which means better outcomes. We keep track of all those health outcomes. Ultimately, health outcomes mean a lower cost of care for all our more than 1 million members.

The last piece, Tom, I would add, is we are beginning to embed social vulnerability indices in the work that we’re doing to further guide the impact that we’re having. What we’re hoping to do is evaluate [whether] and make sure that those communities, those zip codes that are the most vulnerable, are our programs reaching them or not? That’s another cool way of using data to drive a lot of our decision-making.

Lee:

Praveen, the array that you describe is thrilling. It’s tempting to go deeper on many of them. That last part where you talked about getting information based upon zip code, neighborhood, I’m hoping that your colleagues and you will write it up at greater length so people can read about it, as they’re going to be reading about the virtual-first outcomes over the course of the last year.

I want to thank you for doing this interview, and even more important, for doing all this work with your terrific team of colleagues. We’ll be wanting to check in as the years go by and learn with you. Thank you once again for joining us.

Thadani:

It’s my pleasure, Tom. Thank you for the opportunity. We call it greater good. Our commitment has and always will be our members and the communities we serve.



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