The term social determinants of health (SDOH) has taken over healthcare in the last few years. And with good reason—studies say that only around 10% of a person’s overall health is influenced directly by healthcare, where social, environmental, genetic, and behavioral patterns determine much of the rest.
In the pursuit of lowering costs and increasing value, payers and providers are increasingly turning to those social and environmental factors.
Related article: 4 Ways Health Plans and Communities Can Address SDOH
One example of that is the Long Beach, California-based SCAN Health Plan, one of the largest not-for-profit Medicare Advantage (MA) plans in the country. Managed Healthcare Executive (MHE) spoke with CEO Chris Wing about why SDOH matter so much, and how SCAN has seen success in addressing these factors.
MHE: Why are you so passionate about SDOH?
Wing: In my case, my father spent his last years of life in a nursing home. There was no independence, no dignity. Not many of us want to be in a nursing home, but have no other way to get the necessary support that facilities provide. When we address the social factors of health—transportation, meals, and personal care—we’re enabling people to retain their independence and age where they want safely and with dignity. I can’t think of a nobler goal.
MHE: How is SCAN involved in addressing SDOH?
Wing: SCAN Health Plan is intently focused on keeping seniors top of mind. One of SCAN’s first programs was the Social HMO federal demonstration, which provided for the in-home support that enables seniors to age safely at home.
Our members are at the center of our model of care. We have long conducted health-risk assessments (HRAs) for members of our Special Needs Plans and last year rolled out HRAs for all our members. In addition to assessing their physical health and functional status, behavioral and cognitive health, and self-efficacy, we also evaluate their social support system including caregiver or family support, and access to housing, nutrition, and transportation. From there, we can better determine health risks and design an individualized plan to mitigate those risk factors and fill unmet needs through benefits, programs and services, or referral to community resources.
SCAN has provided transportation, hearing benefits, and home and community-based care as part of our benefit packages since our days as a Social HMO. Since then, however, the Medicare rules have not always allowed health plans to offer these benefits to all members (most being reserved for those dually enrolled in Medicaid and Medicare). We are also acutely aware that seniors are more heavily impacted by SDOH issues like social isolation and transportation as well, which are vital to acknowledge and address.
I’m focused on ensuring SCAN understands the issues our members face and then addresses those issues holistically through our benefit plans and community services. That includes:
- Working with providers to improve access to care
- Providing transportation benefits so members can keep their appointments and pick up their medications
- Deploying specialized in-home care management programs for the highest need members
- Training our providers and their office staff on geriatric-specific strategies such as fall prevention, and then incentivizing them to manage fall risks
- Employing SCAN members to call their fellow members who have indicated they need help with issues like bladder leakage, depression and pain
- Helping members access community resources
MHE: Where is healthcare overall in addressing SDOH today, on a scale from 1-10, 10 being the highest?
Wing: Right now, I would say the industry is at a 6 out of 10. There is still a lot of room to grow as far as understanding the services needed to ensure seniors dealing with SDOH are properly cared for. Presently, policy shifts are allowing Medicare Advantage organizations to include benefits that address social needs, as well as creating payment models that make the business case for tackling SDOH on a broader front.