Addressing Social Barriers to Help People Get the Care They Need

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Eating well, exercising and visiting your doctor regularly are all proactive ways to stay healthy. But there are many other factors that contribute, as well – the conditions in which we live, our level of education and our working status. These social, emotional and environmental conditions, known as social determinants of health (SDOH), all play a role in our overall well-being.

Hypothetically, suppose that Janet, an 86-year-old woman who lives alone, hasn’t picked up her prescription. Janet needs to refrigerate her medicine, but she’s worried about paying her electric bill. So she chooses to forget about her medication. In this scenario, Janet’s concerns about her ability to pay her bills becomes a social determinant of her health.    

“Research shows that only about one-third of health care spending in our country is spent on services that support social, emotional and environmental needs. In other countries, they spend much more to address the root cause of medical issues,” said Sheila Shapiro, senior vice president of national strategic partnerships for UnitedHealthcare, referencing research from “The American Healthcare Paradox.”

Typically, physicians and care providers use a data system to classify and record all diagnoses, symptoms and medical treatments or procedures. But to address patients’ health holistically, UnitedHealthcare and the American Medical Association (AMA) are working together to better identify and address social determinants of health to improve access to care and patient outcomes. They’re doing this by standardizing how data is collected, processed and integrated regarding critical social factors that contribute to patient well-being.

To standardize, they are supporting the addition of codes that help identify social determinants and barriers to care. Some of those proposed factors include lack of transportation, inability to pay for a prescription, food insecurity, caregiver needs, isolation and more. The combined social and medical data would enable referrals to be made by connecting people to social and government services in their communities.

“UnitedHealthcare and the AMA share a common goal to redefine our nation’s health care system to consider the whole person – not just medical care – by placing as much emphasis on people’s social needs as we do on their clinical needs,” said Bill Hagan, president of clinical services for UnitedHealthcare. “By working together to leverage data, technology and the expertise of our network health care professionals, we can more effectively address the social factors that limit access to health care.”

Using this data model, UnitedHealthcare has made more than 700,000 social service referrals as of December 2018 for people enrolled in its Medicare Advantage plans, providing an Imputed Market PriceTM of more than $250 million.

In the hypothetical case of Janet, programs like the one UnitedHealthcare has put in place would notice she didn’t pick up her prescription and connect her with local utility assistance and other programs she may need to manage her health. By connecting her to these services, she can pay her electric bill and fill her prescription, which helps to improve her overall well-being.

“By supporting the expansion of social determinants, we’re creating a consistent, standard method for identifying barriers to care, helping to encourage access to quality care and improving health outcomes for the people we serve,” Shapiro said.