At Healthcare Innovation's Texas Summit in Houston on Monday, July 18, Editor-in-Chief Mark Hagland led a panel discussion entitled, “On the Leading Edge: The Role of SDOH Strategies in Population Health.” The panel featured Mital Brahmbhatt, director, health management, population health service organization, Memorial Hermann Hospital System; Mac Marlow, CIO, Southwestern Health Resources; and Nora Belcher, CEO, Texas e-Health Alliance and focused on complexities, challenges, and opportunities integrating the social determinants of health (SDOH) into their population health management initiatives.
Hagland initiated the discussion by asking Belcher to summarize where things are at a collective policy level. Belcher said, “I think it's a fascinating time to be in the policy space because of what I've been calling ‘the rediscovery of federalism.’ We have layers, we're like an onion, we're basically in check at this point—where there's local responsibilities, state responsibilities, and then there are limitations on what the federal government can do. Rational people may disagree about what those are, but it doesn't change the fact that they exist. What I think is a good sign is that we're seeing a lot of activity around SDOH with CMS, and there's the Medicare component, but there's also Medicaid and CHIP. And let me tell you, as someone who has moved technology in the Texas market for Medicaid for decades, once you start to get Medicaid to do things, incentivize things, change things, you start to see response in the rest of the market. I think the federal response there is important, I also think it's going to be important to consider additional federal funding for things like broadband. Because at this point, the internet is a social determinants of health and your access to the internet may or may not determine how healthy you are able to stay. So there are billions of dollars available for that. But Texas, in our usual fashion, just came up with our state broadband plan last year, we have a comprehensive website. That's important because a lot of federal money was going by the wayside for Texas because we didn't have a state plan to mount to. So broadband and the digital divide, both digital inclusion (making sure everyone can use the tools) and digital equity, are important concepts that the Texas Legislature is actually taking fairly seriously.”
“And the other thing that I would mention that I think is going to be really fascinating is the Speaker of the House in Texas has put together a health reform task force,” she added. “And they're supposed to look at cost. They're supposed to look at transparency, but they're also looking at social determinants of health, and how the state's response to these things hits the state's pocketbook. I don't care how they get there. I think sometimes the Texas Legislature is the epitome of Winston Churchill's quote, ‘Americans always do the right thing after they've done everything else.’ But they seem to be more willing to have the conversation.”
Belcher commented, “I'll end with Medicaid moving into shared risk is a game changer. Real shared risk, not just bonuses, not just incentives. And without projects, like the great work that Greater Houston Health Connect is doing, gathering data at the local level, making those connections, their stuff gets a lot harder to do. Everybody has to pull more together, instead of being in these silos that no one would build starting from scratch. But the federal policy and the state policy is more focused because the truth of the matter is, they've done everything they can with Medicaid rates, and none of it has worked. So they're willing to be a little bit more open and creative on this front.”
Hagland asked Marlow how health IT leaders, data scientists, and data analysts are going to move forward in terms of how the data can help. “We have the two large organizations that were involved with, we have hundreds of independent individual independent practices, but they all have unique individual instances of an EMR,” Marlow said. “We work very diligently to pull together all EMR data and clinical data, we merge it with claims data in a population health management platform. And we do a lot of analysis. We’re dealing with not gigabytes, or terabytes, we’re working petabytes of data. We’ve got to be able to move through that data in a meaningful way.”
Marlow added, “Let me give you an example on the social determinants of health side of some of the things that we're looking at. We do have data scientists, we also partner with other organizations to help us run propensity models, looking at the data that we have, and things in the clinical side. We're taking geolocation data—which is pretty simplistic people, been doing it for a long time—we're actually bouncing it up against the Department of Motor Vehicles to find out which homes have registered vehicles and which ones do not. Because what we know in the provider world is that no show rates can get pretty astronomical.”
He went on to explain that in the provider world a lot of times it is just about looking at who is going to pay their bill, but Southwestern Health Resources is looking for a propensity for them to go to their appointments and what can be done to intervene. If the patient doesn’t have registered vehicles at their residence, they likely don’t have a way to get themselves where they need to go from a provider perspective. Marlow says that perhaps intervention could include a social worker reaching out to the patient to determine how they can get to their appointment.
Brahmbhatt commented, “From a provider standpoint, we've heard the message and are taking the assignment. We created what we like to call our ‘Batline’ to our providers. We’ve identified that our providers need help, they have limited bandwidth in their clinics. If they have identified patients on their panel that they're saying are not compliant here or they're in a clinic visit, they've talked about depressive type symptoms that are preventing them from coming to their visits, we've created what we call our community care coordination team to get those community health workers involved so that the provider can now reach out to them directly. We've created an e-referral process through our EMR for them and for independent providers. We're still using email, but we'll get there. Yet, it's still an opportunity for them to reach out and say, ‘Hey, I need help for these five patients.’ Because if we can remove all those barriers, we know that people are compliant with their care and being more engaged in their overall health journey.”
Hagland asked Belcher, “Are states learning from each other?” She said, “States are absolutely learning from each other. Now, if you see one state Medicaid program using one state Medicaid program, to be fair, they can all be very different. A great example of that is our emergency preparedness workgroup at Sequoia, we have public health people, emergency preparedness people, we have Medicaid people from different states that are all doing implementations, learning from each other. And that has really been extraordinary because those people, in some cases, are in the same agencies and still don't talk to each other. We're trying to really tear those silos down between those three channels.”
As for final thoughts and predictions for the future, Marlow said “It's not just the payers, it's not the providers, it's not government organizations, it's everyone, we're all part of the community we offer with each other. I think being aware is key and sharing and educating others. If there's not a wealth of that, and there's not enough people supporting people, that's really what we need at the end of the day.”
“I think one of the things we need to take away is that everything that we do for patients should be person to Senator,” Brahmbhatt commented. “We should always engage with our patients [in] very nurturing language and ensuring that, of course, the dollars and cents make sense. However, I think that our future is contingent upon optimizing a person's well-being, so that their tomorrow is certainly better than their today. And that just goes back into language and interaction. And predictably, technology cannot go anywhere if you don't have the right people and processes in place.”
Belcher concluded, “I think we're asking the right questions, and keeping the patient at the center is really, really important. But we have to watch the shift to providers.”
