I’ve been writing recently about my thoughts on what the COVID pandemic will mean for the future of the Health Care and Health Plans.

Obviously this year’s reporting system is going to be wild.

But, there is also big opportunities with the rise of telehealth.

I see a major shift to even more value-based care.

And the biggest trend that will rise out of this?  Social Determinants of Health (SDoH) will become an even bigger factor.

Social Determinants of Health Move to the Forefront

The “theory” around SDoH has always been fairly obvious:

• Health is more than just the absence of disease or symptoms, but a holistic wellbeing.
• Overall health is largely influenced by the environment and social determinants such as socio-economic status, living conditions, and social interactions.
• Doctors that are aware of the social determinants can prescribe more effective treatments taking those into account.

However, the application has always been the difficult:

• Typical fee for service reimbursement incentivizes treating symptoms and acute conditions rather than maintaining holistic health.
• Collecting information about a patient’s social environment is out of the “norm” for most provider practices.
• Patients may be reluctant to share information with their doctor about their living conditions.
• Delivering data collected by health plans can be cumbersome and difficult to update.
• Simple “risk scores” alone can miss key details and nuances that alter course of treatment.

The shift towards value-based care has started to change this, however.

• With capitation and risk models in place, it’s become financially important for health plans and providers to keep their patients healthy, and not just treat their illnesses.  That makes CFOs just as interested in holistic care as CMOs.
• With COVID, we’re also seeing CMS shift rules on telehealth, which can open up all kinds of potential for actually understanding a patient’s environmental conditions.
• There are already several key players in the space that are aggregating consumer data that can be used to develop SDoH reports on key factors.
• And at iCare, we’re constantly innovating on provider engagement and communication between health plans and and delivery of that customized SDoH data is something that we’re working on right now.

The Opportunity

I’ve mentioned it before, among the many hard lessons COVID is teaching us, maintaining a healthy environment and lifestyle is just as important, if not more, than merely treating ailments and symptoms.

Obviously, we can’t control the choices people make, but health plans and physicians can provide a significant influence and help mitigate the risks to health people face on a day-to-day basis.

That will require a continued shift in our health care culture, and of course, a lot of data.

We’re happy to a be a part of that journey,

-John