Our health system is transforming, moving from a fee-for-service model to a value-based, coordinated care delivery system.
As this effort continues to gain momentum, providers are starting to take a closer look at the capabilities needed for success under alternative payment models, such as accountable care organizations (ACOs).
A recent study conducted by The Robert Wood Johnson Foundation (RWJF) and Premier Inc. looks at 19 fully-integrated ACOs, to determine how these organizations are managing health outcomes. According to the research, one of the most important elements to creating a successful ACO is to manage the social determinants of health, including care management strategies that provide high-touch care to high-cost patients.
Social determinants of health vary by population. That's why when it comes to creating an effective care management strategy, it is critical to cater to the unique factors of the community. According to the Centers for Disease Control and Prevention, social determinants of health are defined as the "conditions in the places where people live, learn, work and play that affect a wide range of health risks and outcomes." For example, consider individuals suffering from unmanaged asthma. Those who live in poverty are more likely to reside in communities with poor air quality, and less likely to have the education and means to treat the asthma, as well as understand what resources are available to them. This is one of many scenarios that provides a clear link to the impact social factors can have on health outcomes.
Managing and improving a person's health isn't limited to what happens within the walls of a doctor's office or a hospital. In an effort to manage the social determinants of health, providers have started to engage with community partners. These groups include local faith communities, schools and other organizations created to help those in need. In fact, research from the RWJF study found that 84 percent of ACOs cited that increased support from their community partners created an immense opportunity for improvement. This included enabling community organizations to be more effective in meeting the needs of the mentally ill and chemically addicted residents, as well as teaming up with employers and local gyms to offer exercise and nutrition-based counseling to address preventative needs. Something as basic as providing transportation can have an impact on patient adherence to a plan of care.
Other components for an effective care management strategy that address the social determinants of health include health education on when and where to access care, which can reduce over-utilization of the emergency department - a key contributor to increased healthcare costs. Providing education to both patients and staff is one way to influence decisions about health outside of the hospital, especially in communities with high incidence of health illiteracy. Recognition of health illiteracy and creating a culturally competent workforce are key to closing gaps in care for our communities.
One effective care management strategy is asset mapping, which can be used to ensure that a community's behavioral resources are not only current, but also available to the public. One Premier member ACO implemented this initiative by collecting information on local behavioral health resources and creating a public map of the assets, providing critical information to the community, all in one place, connecting providers, and identifying assets that were previously unknown.
Managing the health of our communities is key to realizing success in a value-based payment world. For far too long, we have underestimated the importance of preventative care and the external factors that can profoundly impact health outcomes. One of the benefits of ACOs is that they incent healthcare providers to think about how to organize community resources to address social determinates of health. Having an effective care management strategy that recognizes and addresses the social determinants of health will help improve the health of patient populations across the continuum of care.
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