Payers, Startups

Solera Health partners with Blue Cross Blue Shield Institute to tackle social determinants nationwide

Solera Health helps find and organize community-based and digital programs – and importantly – facilitates their reimbursement through the medical claims process.

social determinants of health,

Phoenix, Arizona-based Solera Health, which builds networks of evidence-based programs that improve health and well-being, has signed a new partnership with the Blue Cross Blue Shield Institute to tackle social determinants of health nationwide.

Essentially, what Solera does is find and organize community-based and digital programs, connects them to patients – and importantly – facilitates their reimbursement through the medical claims process.

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When it launched three years ago, the company started out in the diabetes prevention space, helping to reduce the administrative complexity that comes along with working with hyper-fragmented individualized programs.

Since then, Solera has branched out into other chronic conditions and much broader services that are meant to tackle the social determinants of health. The company has raised more than $30 million in total from investors including Blue Cross Blue Shield Venture Partners.

“We started thinking that healthcare happens in healthcare settings, but health happens in the community,” said Solera CEO Brenda Schmidt. “We wondered if we took a really holistic approach, what were services and social programs that people need that are outside the four clinical walls?”

With that mission statement, the company started organizing resources to tackle issues like food insecurity, transportation, behavioral addiction and substance abuse resources. Schmidt said the company performs an important function in curating their networks to ensure that patients are only connected to high quality programs.

Solera’s new partnership with the BCBS Institute stacks on top of the payer organization’s existing focus on building out community health resources by identifying and connecting specific health plan members that would most benefit from those services.

“Because we’ve already created this huge national network of community organizations, for us to plug in other programs and services is really straightforward,” Schmidt said.

Besides food insecurity and transportation, other major focuses include programs that tackle social isolation, financial insecurity and fall prevention.

Social determinants of health have been a stated strategic priority of the Blue plans and the BCBS Institute has developed tools like its Community Health Management Hub to help simulate what kind of resources could have the biggest impact on claims.

Solera has been piloting its partnership with BCBS Institute in a few key markets and plans to roll out increased capabilities over the rest of the year.

Schmidt used the analogy of “” to explain how the company connects patients to services that match personal needs, instead of just providing a directory. For example, honing in on why exactly a person is food insecure and linking them to resources like SNAP, transportation to a grocery store or a food bank.

While payer organizations have increasingly underscored the importance of addressing social determinants of health, developing an actual payment structure for those resources has proven difficult. That’s where Solera’s innovative financial model can step in.

When it comes to actually developing a reimbursement structure around these kind of non-medical resources, the company measures outcomes on a pre and post basis.

“We’re submitting claims to the payer when we enroll someone in a program as well as when we can demonstrate that we have reduced the risk of an individual through that intervention,” Schmidt said. “We’ve been really creative with our health plan clients to determine CPT codes – typically prevention codes – that we can bill against.”

That creates a more sustainable financing route (past grant funding) which can create an evidence base for payers to see the impact of supporting these programs. Schmidt added that Solera’s vast knowledge base and presence in regional markets allows it to act a “advocate” for hyper-local organizations which can be difficult to find from a national payer perspective.

“The future of healthcare prevention moves away from the clinical setting into the community setting. This transition means that food, fitness and transportation will become an integral component of how we evaluate holistic approaches to the health and well-being of our population,” Trent Haywood, president of the Blue Cross Blue Shield Institute, said in a statement.

“The collaboration with Solera will help us to better understand how we can address social determinants of health quicker and more effectively.”

Photo: vaeenma, Getty Images