Value-based payment (VBP) arrangements enable health plans to address the bigger picture when it comes to their members by factoring social determinants of health (SDoH) into the value equation. Many aspects outside of a clinical setting—transportation, nutrition, housing, employment, health literacy, etc.—are shown to have an indirect but significant impact on care. In fact, it’s estimated between 80-90% of outcomes are affected by some form of SDOH.
While social determinants of health impact patients outside the purview of provider care, the good news is that they can be modified. Avoidable hospital admissions and emergency department visits are big drivers of unnecessary spending for health plans, but many of these instances can be prevented by connecting patients and providers to the right community-based organizations (CBOs). By comparison, these interventions are low-cost. How do you get the ball rolling, though? The answer: trust through technology.
Trust is the foundation for all successful value-based payment arrangements, particularly in the case of contracts that incorporate SDoH elements. When payers work with those affected by health or social disparities, trust between all parties, which includes payers, their provider networks, and CBOs, is crucial to overall successful patient care. But how can payers go about building a sense of trust in their relationships with providers and CBOs?
The first element of building trust is making sure that the providers in your network are on-board and engaging in your VBP arrangement. You want to make sure that contracts are mutually beneficial to both parties and that contract terms and conditions take into account your provider network’s concerns regarding their patient population. Once you enter a contract, you can maintain this trust by establishing data transparency through an effective health analytics platform. This can be done by facilitating data sharing with your provider network via access to your claims data. This will enable providers to modify care delivery, improve overall population health, and increase ROI. It also allows them to easily see gaps in care and how they’re performing against the terms of the contract. With more information upfront, providers can feel more confident in their reimbursement and their care decisions.
Another key component in developing trust is making sure the care team is properly coordinated throughout the entire patient journey. Without proper care coordination, important referrals and services can slip through the cracks, leaving your members in the dark. As you work with your CBOs, identify key metrics to track and commit to tracking them through the entire contract term. You want to make sure important data is getting to the right people at the right time. With the right analytics solution, you should have role-defined access that allows users to incorporate the data they need most to deliver their best results. Without this, roles and responsibilities may not be properly established, and as a result you may see your program struggle to determine who should be screening, recording, providing intervention, and tracking performance.
Social determinants of health present an exciting opportunity to transform care. Addressing SDOH also positively impact the communities you serve from the outside in. By building trust via technology with CBOs, providers, and patients, you can generate cost savings and avoid unnecessary healthcare spending.