Much has been written lately about social determinants of health – the social and economic factors that can impact your health like where you live, what you eat, how secure you feel and how connected you are to those around you. Without these factors in place, individuals may experience higher rates of disease, health complications and higher costs associated with their healthcare. In fact, a recently published study in the American Journal of Managed Care revealed that individuals with unmet social needs were 68 percent more likely to be readmitted to the hospital within 30 days of discharge.
Today, 50 percent of physicians agree that assisting patients with social determinants of health matters for wellbeing, but the majority do not feel well-positioned to help address or discuss social determinants with their patients for a variety of reasons, whether it’s due to lack of time, resources or understanding.
Therefore, it’s critical that all of us in the industry step in to help.
Addressing social determinants of health
At WellCare Health Plans, we provide managed care services, including Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, to 6.4 million members across the country. For many of our members, health happens outside of the doctor’s office. Whether it’s access to healthy foods, transportation to medical appointments, or safe and affordable housing.
To address these challenges and help our members achieve better health outcomes, we established the Community Connections program, which leverages an integrated social services management platform to assess the social needs of our members and local communities. By partnering directly with thousands of community-based organizations across the country, WellCare has developed a program that allows us to exchange community-level data that helps drive quality programs, community-level investments and innovation priorities, all with a goal to increase access to care and improve health outcomes.
To support our model, WellCare established a boots-on-the-ground approach. We employ field-based, community engagement teams, which help identify social service needs in our local communities, and a Community Connections Help Line, a toll-free, nationwide line available to both WellCare members and the general public. The Help Line is staffed by a diverse team of Peer Coaches who use their own personal experiences with the social service system to refer callers to a database of more than 500,000 programs and social services available across the country.
Improving health outcomes and lowering costs
Since launch, WellCare’s Community Connections program has provided nearly half a million referrals to those in need, resulting in improved health outcomes and lower costs. According to an analysis of WellCare’s efforts, those connected to services experienced a nearly 10 percent reduction in healthcare costs and, compared to demographically similar members, those with social barriers removed were nearly 5 times more likely to schedule and attend a visit with their primary care doctor; were 2.4 times more likely to improve body mass index (BMI); and were 1.5 times more likely to comply with diabetes treatment.
To gain further insight into the most requested social service needs of callers and the needs in our local communities, WellCare examined more than 106,000 social service referrals made through the program for the first half of 2019. Top requested referrals included family support (20 percent), such as child care and child welfare related services; food access (16 percent); transportation (16 percent); utilities assistance (11 percent); medication assistance (7 percent); and housing (6 percent). Further, social service demand was highest among the oldest and youngest callers. One-in-four referrals was for people ages 65 and older, while one-in-five was for children.
The research further established a connection between social service needs and chronic disease. According to the study, members with social service needs were managing nearly four chronic health conditions, including at least one behavioral health condition, which is more than twice the rate of patients without social service needs.
Programs such as WellCare’s are making important inroads on services, strengthening the social safety net, lowering costs and improving outcomes.
A path forward
At the end of the day, it’s incumbent on all of us in the healthcare industry to step up and, at a minimum, understand social determinants of health, knowing that they have the potential to affect everyone, no matter their socioeconomic circumstances. We must then assume responsibility for recognizing and, ultimately, addressing these factors to ensure individuals can achieve better health outcomes and healthier futures.
Rhonda Mims is the executive vice president and chief public affairs officer of WellCare Health Plans, Inc.
