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2 big new ways to fund your population health investments

March 21, 2019

    We've reported widely on the creative ways provider organizations have been addressing social determinants of health. After our countless conversations with leaders in the field, we know there's no limit to ideas of how to address psychosocial needs. However, the health care industry isn't designed to make it easy or financially viable for organizations to make serious investments in this space.

    The two biggest barriers to large-scale social determinant-based investments are a lack of data for allocating resources and insufficient funding. Population health departments have tight budgets and many competing priorities, so leaders don't make strategic decisions without sufficient support from the data. But providers and plans haven't traditionally collected data on social needs. And while community health needs assessments have helped size the challenge of social determinants of health, these data sources aren't enough for organizations to prioritize social interventions above traditional, revenue-generating investments.

    Two big announcements could facilitate funding

    While lack of funding continues to slow some providers' progress when addressing social determinants, two recent announcements could pave the way for reimbursement.

    1. Private payers are exploring ways to reimburse through fee-for-service codes

    UnitedHealthcare has joined public insurers by implementing ICD-10 Z-codes to track social needs and services for Medicaid beneficiaries. Z-codes aren't new—but major health plans taking them seriously are. These social determinant-focused codes could serve as a tool to aggregate and communicate data on patients' psychosocial needs. However, they're underutilized by providers due to a lack of education on their importance and limited financial incentives. By putting the spotlight on z-codes, UnitedHealthcare is trying to formalize their usage and build the database.

    Editor's note: The Care Transformation Center Blog is published by Advisory Board, a division of Optum, which is a wholly owned subsidiary of UnitedHealth Group. UnitedHealth Group separately owns UnitedHealthcare.

    2. Federal channels continue to provide funds to explore provider-community partnerships

    The Accountable Health Communities and other well-known demonstration projects have been up and running for two years. But more recently, the Department of Treasury (DOT) announced a funding opportunity under the Social Impact Partnerships to Pay for Results Act (SIPPRA) to allocate funding for partnerships dedicated to addressing social needs.

    SIPPRA, which was passed as part of the Bipartisan Budget Act of 2018, allocated more than $66 million to state or local governments that implement social service partnerships that show positive outcomes. Coalitions (including governments, hospitals, community partners, and more) can apply to enter into an agreement with DOT. If accepted, the coalition will implement the intervention with the potential for payment in the long term.

    These announcements are just two indications that the industry is ready to start putting money behind the social determinants of health. When your organization is ready to join in, tap into the Population Health Advisor's suite of resources.

    Your next steps

    To set a system-wide strategy for addressing the social determinants of health, review:

    For deeper dives on implementing community partnerships to address specific social determinants of health, review:

    For a higher-level introduction into how to identify and address major community health needs, review:

    • Advancing health equity: This webconference provides an overview of methods to identify health disparities on a community and patient level to inform strategic priorities and improve outcomes of at-risk patients.
    • Address patients' non-clinical risk factors in ongoing management: This webconference outlines how to partner with community-based organizations already providing quality non-clinical support for a range of needs to scale patient management.

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