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:
- 3 imperatives for investing in successful community partnerships: This briefing outlines how to specify internal priorities for pursuing collaboration, rally external stakeholders across a common mission, and design a framework for financial sustainability.
- 10 tools for prioritizing community health interventions: This briefing helps define core measures of community health success, tactics for prioritizing interventions, tips on creating formal partnership compacts, and ways to measure performance.
- Integrating psychosocial risk factors into ongoing care: This briefing provides an overview of how to deploy staff to assess for and address patients' psychosocial needs, as well as a special report on evidence-based interventions that target the major social determinants of health.
For deeper dives on implementing community partnerships to address specific social determinants of health, review:
- Provider-led strategies to address food insecurity: This study outlines five action steps and best-practice models for implementing programs to address food insecurity.
- How to close the housing gap through strategic partnerships: This study makes the case for investing in wraparound housing support to reduce housing insecurity and improve community health outcomes.
- Mobile health clinics: Improving access to care for the underserved: This study provides an overview of best practice models for operating a mobile clinic to improve access to care for vulnerable populations.
- Working with faith leaders to optimize health system engagement: This study reviews the benefits of working with religious institutions, four types of congregational health network models, and key considerations for the formation of an effective network.
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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