A growing body of evidence is showing that an individual’s social, behavioral, and environmental factors contribute more to that person’s health than traditional medical healthcare services. Health plans are looking to these social determinants of health as means to reduce readmissions and improve health while reducing healthcare costs for their members.

Health organizations must recognize the importance of social determinants of health

Many U.S. citizens have comorbid health issues. About 25% of Americans have multiple chronic health conditions, according to the U.S. Centers for Disease Control and Prevention. That percentage jumps when looking at the country’s aging population — 75% of Americans aged 65 or older have multiple chronic conditions. These conditions come with a high price tag. More than 70% of total U.S. healthcare spending is tied to care related to those with more than one chronic health condition. In one study, 47% of the top 5% of healthcare spenders had multiple chronic diseases as well as a functional inability to care for themselves or perform daily tasks. In the face of an increasingly aging population with a varying set of comorbid conditions, providers and payers are looking toward other avenues of preventive care, including efforts associated with the social determinants of health.

How in-home care can fill social determinant gaps

Because social determinant needs are varied — from lack of housing and job security to food insecurity — efforts to address them in different populations can take various shapes. Housing could be one area that payers and health systems could tackle, for example. Just recently, the Department of Health & Human Services Secretary Alex Azar suggested that the Centers of Medicare and Medicaid Services could reimburse payers for housing and other social services. One group of researchers in 2016 foresaw the benefits home care could have for the overall healthcare system. They concluded that “the future of healthcare delivery hinges on the ability of payers and providers to leverage the spectrum of home-based care.” It’s not hard to see why. The national readmission rate is 17.5%, and important contributory factors are beyond the discharging provider’s control. It’s no surprise then that healthcare organizations like payers are looking to home care services — which include medication reminders and oversight, companionship, and exercise — as a formidable and scalable preventive health tool. One CareLinx partner, for example, was able to prevent avoidable admissions to acute-care setting by deploying our Medicare-at-Home solution.

How one health plan rethought the home for preventive care

A nonprofit Catholic integrated health system with a health plan looked to rethink the organization’s home care efforts for its complex members. These members impacted the health system and health plan by over-utilizing services, driving up expenses, straining facility resources, and increasing total cost of care. To mitigate system-wide pressures and restore a healthy foundation to the members’ lives, the organization sought to prevent inappropriate admissions to acute-care settings. The organization knew the move would be part of a broader shift in rethinking preventive care. For Americans 65 and older, over 80% want to stay and age in their home or community, according to the AARP. Knowing that demand for home care services would grow as the population aged, the organization looked for a partner that could meet members’ current health needs with the ability to scale overtime. The organization partnered with CareLinx and deployed the company’s Medicare at Home product. Early recognition of changing health statuses allowed for timely, actionable insights into a person’s health condition. When appropriate, proactive interventions were made before conditions worsened and admissions were needed.

Boost your readmission reduction strategies

Within months, readmission rates since implementing the program were significantly reduced. Learn more about their success story with our latest case study: CareLinx Case Study: Early Intervention in the Home Positively Affects Member Outcomes

December 11, 2018
Health Systems

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