On July 15th, as many as 14 million Americans risk losing their Medicaid coverage if the nation’s public health emergency isn’t extended. Not only will that have a devastating effect on those Americans who find themselves without coverage, but it will also have a significant impact on healthcare costs, potentially driving costs higher as providers switch to a more complex and complicated reimbursement model. A model that currently contributes to the United States paying 600% more for medical care than it should and still producing the worst outcomes of any high-income country.
Our current system is broken. It doesn’t have to be this way.
Health Benefit Consultants, Share Your Expert Insights in Our Survey
Ted Quinn Ted Quinn is the Chief Executive Officer and co-founder of Activate Care. He earned his B.A. from Brigham Young University and his M.B.A. from Harvard Business School. Since graduating, Ted has acquired 25 years of experience working in technology and healthcare.
A huge area for change is to address how and where we direct our healthcare spend. Right now, according to multiple studies 90% of healthcare expenses nationally focuses on medical care, which only directly influences 10-20% of health outcomes. In reality, 80-90% of a person’s wellbeing is driven by the social determinants of health (SDOH) they face on a daily basis. Where a person works, lives, eats, plays, prays, the job they have, the schools they attend, the air they breathe and water they drink every day have almost a tenfold impact on their health than any medical treatment. There is a significant opportunity to make an impact if we focus on how we address SDOH, specifically, how we could change from a reactive to a proactive approach.
In the current reactive paradigm, for example, a person would have to show up in the emergency department, receive costly care, and then upon discharge we try to address some of the non-clinical drivers of their health status, like a lack of access to food and medicine or an unstable housing situation. But what if we addressed SDOH proactively, identifying those at risk before they end up in the ED? With proactive outreach by highly trained community health navigators guided by data and leveraging easy-to-use technology, we could get ahead of an individual’s needs, design and execute a care plan, and – hopefully – keep them out of the hospital.
By turning our focus to proactive whole-person care, we can ensure the right people receive the services and care they need, improve and reduce healthcare disparities and lower avoidable healthcare spend.
Proactive engagement is key to driving improved outcomes
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Findings of a 2019 study revealed a strong link between SDOH and the development of chronic disease. As discussed during last year’s MedCity INVEST Digital Health event, people often have overlapping SDOH that are the root cause of their medical issues. Current models tend to treat and track these issues, be it housing or lack of food or financial situation individually, which in turn lacks effectiveness and misses key aspects of a person’s lived experience and situation that are critical to eliminating those factors and driving improved health outcomes at a lower cost.
A 2019 study found that food insecurity (an SDOH) – which can lead to diabetes, heart disease and other chronic conditions – costs the health system an additional $53 billion a year.
In one community – Nashville, Tennessee – the annual cost of all hospital services used by 74% of the homeless population is nearly $3.5 million (a cost of roughly $1,500 per homeless individual). The cost goes up when you factor in medical clinics, mobile emergency medical services and Veterans Affairs.
As a healthcare system, if we start using data to proactively identify at-risk individuals, engage early, leverage technology to manage and track their journey and rely on trusted community health navigators to provide 1:1 support, we can have a significant impact on Americans’ overall health outcomes.
By simply identifying people living with, or at risk of, food insecurity, we can significantly reduce the health consequences that it causes, which can be many and last a lifetime. Likewise, by proactively addressing people experiencing housing insecurity and chronic homelessness, we can improve their quality of life, health outcomes and reduce the high costs carried by local healthcare providers and systems.
Care needs to come from the community
Moving upstream, being proactive with outreach and navigation is easier said than done. Who takes on that responsibility? With added responsibilities and staffing challenges, clinical teams have been extended to the breaking point. This is particularly pronounced in rural communities across the country. Additionally, Community Health Workers (CHW) in the community today are past capacity—for every 1 person served by a CHW there are hundreds more not being reached that could benefit from help. Nobody serves as a quarterback to navigate those seeking help and the range of professionals already working in the community to provide services.
That is why we need to move to a model that combines a data driven approach to identifying those in need with highly trained professionals who are proactively doing outreach and care planning for individuals. To be successful you need to have people with lived experience in the community that can provide guidance, trust, and can educate and empower people to get the help they need. There are a lot of great programs and services out there, communities of care that can be tapped into. People just need help to get access to that care before it is too late.
We need to move treating SDOH from reactive approach like treating a broken arm or heart attack to more of a preventative medicine model- early screenings work to diagnose and treat cancer, smoking cessation programs reduce lung cancer, regular check-ups prevent small issues from becoming critical- why can’t the same be done for SDOH?
When we wait for issues like food and housing insecurity to turn up in our EDs, or rely on our healthcare system to address and treat these issues, we are missing the opportunity to drive substantive change.
Effectively addressing SDOH cannot happen overnight, but it absolutely can be done. It requires building trust between members and their communities, and empowering them to participate in their care and take advantage of their community services. As our industry, state and local governments work to address SDOH, we believe more proactive, better coordinated care coming from the community is needed to make a lasting impact for so many of our neighbors struggling today.
Photo: vaeenma, Getty Images
Ted Quinn is the Chief Executive Officer and co-founder of Activate Care. He earned his B.A. from Brigham Young University and his M.B.A. from Harvard Business School. Since graduating, Ted has acquired 25 years of experience working in technology and healthcare.
