Understanding Health Plans with Sam Robinson
Published Apr 16 2020 08:24 AM 2,313 Views

On episode 1 health plan expert Sam Robinson talks about social determinants of health and the relevance in today's society.


Claire: You're watching the Microsoft US Health and Life Sciences Confessions of Health Geeks podcast. A show that offers industry insight from the health geeks and data freaks of the US Health and Life Sciences industry team. I'm your host, Claire Bonaci. Today we begin a Health Plan series with Sam Robinson, our National Director for US health plans, discussing social determinants of health and the biggest myth he wants to clear up about SDOH. Hi, Welcome Sam, our health plan expert. Thanks so much for joining us today.

Sam: Thanks Claire, thanks for inviting me on the podcast.

Claire: Yeah, of course. So we've been hearing a lot about social determinants of health or SDOH. And often SDOH is conflated with population health. Can you explain what SDOH means from a health plan perspective and give the listeners a quick run down on the differences between the two.

Sam: Let's start from the beginning. Social determinants of health are really a way to collect and measure the factors that happen to you and affect healthcare and health expenditures outside of what happens within a care setting. Think of a care setting as you go to the doctor or you go to the hospital. Outside of that your diet, your exercise, all the things you've been told by your doctor all these years. That actually affects your overall health and your health expenditures. Generally we break down social determinants of health into some very broad categories now that it's getting a lot more attention. Economic categories - think of income is the major driver of that. Another closely related is education. So first of all we don't have much of a literacy problem in this country but we have some. Can you read, can you understand in the language that is presented to you? Can you understand what people are telling you in the health system. Big problem. Then in addition we do find higher education level, the different experiences, or how you'll consume resources. Environmental factors are huge, pollution, noise, light pollution. all that affects your health outside of it. Do you live in an environment that is conducive to that? Food. You're hearing a lot in the news now about how to get food to people that need it. The term they use now is food insecure for example. What that means is that you don't know where you'll get healthy food at an affordable price day to day. And social. Social covers a lot. I know we're on a bit of social media here but what is your support environment. Do you have people that can bring you food, that can make sure you're taken care of? That your prescriptions are taken care of. And lastly, health itself I know that gets the most attention but do you have access to providers and hospitals, are you covered, do you have insurance. And all those factors and even literacy again, how much do you understand when someone is talking to you about the health insurance industry, what that means or the health provider industry, what that means. And these factors can determine a lot of things. So at a population level, you mention population health, where do I need to address programs, where do I need to help people in specific areas that may need more food or more services. And secondly on an individual level, gosh if I could measure everything that happens to you outside of the healthcare system could I design programs or know your ability to take up programs that would help your overall health outcomes.

Claire: That's great, I love that you bring up healthy food not just food and the mental health piece of do you have support system and people around you. Those are very important. I love that you bring them up. So these ideas of SDOH, social risk factors, population health are not new. So why do you think these terms are now entering the mainstream of US health markets? Why now basically.

Sam: Well there's lots of reasons. First, health like every part of our society is trendy. As soon you have an acronym, SDOH that you just said, thank you for that. That SDOH acronym, everyone wants to do it, every company, provider, vendor of any sort is now jumping on the SDOH band wagon. but more importantly it gets at a very core concept. We talked about population health and often its conflated, population health and social determinants. You hear that a lot when you talk to folks, aren't they the same thing? No in fact population health is for a given group of people, however you define them, geographically, by employer, however you define them, how can I maximize the health outcomes of that entire group. And then when we look at that we look at the second part of population health which is are we equitably putting resources to that group to get everyone a similar health outcome. SDOH on the other hand is a way of getting that additional information and moving that into that process so that we can distribute resources within that population to raise everyone's health. And this has implications for individual health, for overall expenditures, all the way through to even a pandemic where you want to know who needs what resources when to maximize their health outcomes but also maximize what the entire population is doing because as we've seen now and all the time is your health affects everyone else and everyone else affects yours. So we all should be in the business of population health because we want to raise everyone's health to a new standard.

Claire: Okay, so these factors are actually really helpful to health plans and health systems

to help the community overall.

Sam: Absolutely, it is what they do day to day. You could even say that a health plan is in the business of population health.

Claire: So Sam as health plans initiatives related to social determinants of health grow and

there is a greater clarity around these concepts, what factors are needed for a strong implementation and evaluation?

Sam: Sure, I'll give you the top three factors. Data, Data, Data. We need the data. So what's really interesting is it's caused a revolution in the business. So these are new data sources, some we've had around but not at these levels. Think of zip plus four information. What are people around you, believe it or not, we tend to group as people. Your neighborhood that you're sitting in right now watching this, is going to affect generally who you are. It tells us income level generally, eating habits, health habits, exercise habits, things of that nature. So that information is great, we've had it. Now combine that up with new data, fitness data, other data that comes in. That's great we have all these new sources. What we're finding is they have to be combined with the existing experience sources. So what is your care sources, from providers, clinical information, claims information. and that generally is used for transactional purpose and hasn't been digitized in a way that we can combine it with other sources. It might be digitized in a data warehouse that you've had for 30 years but isn't that useful. But now combining that up with the holy grail which we call longitudinal record or health record or longitudinal health record of you incorporates that and even other sources, like your social media if you'll let us get it. Then measuring that and saying "how did we do?" we expected them to use this program did they do it? and that gives us what? More data right. And how do we combine that performance data back in.

Claire: Great, it comes down to insights and data that makes sense.

Sam: That's right, simple.

Claire: Sam we have 1 minute left what is the biggest myth about SDOH that you want to address?

Sam: Well that its the next silver bullet. We talked about that at the very beginning. We love a trend we love to bring things in. But it's not. There is no silver bullet. We have a very complex payment and delivery system in this country and its all mixed into winners and losers and that makes it difficult. But what's key about SDOH is it's changing the conversation from how do I do better health care delivery, ie how do I deliver a service better, how do I get people out of the hospital quicker, or do I avoid hospitalization. All care, care, care, it's important in disease management to health outcomes. How do I make sure everyone in my population is reaching their maximum health potential. That is fantastic as us as a country, for health payors specifically. And even eventually to providers once they adjust to the new health outcomes mantra. And through payment mechanisms like value based payments we're starting to move the needle a little bit but SDOH provides key information that will help us deliver on health outcomes and truly make it an affordable proposition for everyone in this country not just those that can afford it.

Claire: Great, well thank you so much Sam!

Sam: Thank you for having me.

Claire: Thank you all for watching. We look forward to having Sam back next month. Please feel free to leave us questions or comments below and check back soon for more content from The HLS Industry team

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