Tag: care management

While the various waves of vaccine priority may be largely defined, the ability for many providers to segment their patient populations based on those designations isn't always simple. Without accurate data, there’s a risk that some vulnerable patients will be missed out. We interviewed Mindy Pankoke, senior product manager at Experian Health, about the challenges in segmenting patient populations for the COVID vaccine and how providers can best overcome those challenges. How does addressing patients’ barriers to care increase vaccination rates? The early versions of this vaccination have two doses which comes with its own set of challenges. Getting a vaccination is one thing but getting people to follow up for a second dose in a certain time frame is another. It’s the non-clinical factors that will prevent patients from getting the vaccine. So, things like inflexible work schedules, lack of transportation or even the access or comfort levels with technology required to schedule an appointment online can prevent patients from receiving or prioritizing the first and/or second dose. It can be an uneven playing field with those patients that do not have more flexible schedules, a vehicle or even access to the proper technology to schedule and register for both doses. It’s much easier for patients to prioritize getting the vaccine when those non-clinical factors are a non-issue. What challenges may providers face when trying to segment patient populations for vaccine administration? There are a lot of gaps in patient demographics which can make it difficult for providers to accurately identify and segment patients. Think information like date of birth or occupation. If providers want to segment by age, which many will likely do for the first wave of vaccinations, that would require a complete record of every patient with an accurate birth date. Providers may also want to segment by occupation, knowing essential workers are also eligible for the vaccine. But how can you understand who is an essential worker? Especially when that definition may vary by state or local government? Including non-clinical insights and enhancing demographic data as part of the patient record can help providers fill in the gaps and better segment patient populations for vaccine administration. By combining the power of Experian’s consumer demographic information with more than 40 years of experience compiling consumer data from self-reported and state license boards, Experian Health is able to drill down into occupation data to view different types of employment (construction, utility, etc.) for you to use to outreach, verify and streamline the scheduling (and automated scheduling) or the COVID vaccination. What are some best practices to move from identifying at risk or priority populations and operationalizing that information into actually administering the vaccine to those groups? This is really where it all comes together, and really where providers need to act fast. Once a group is identified, providers can automate the process as much as possible. First, it is imperative that providers clean up their data. Recent processing of Experian’s Universal Identity Manager solution has identified 1,800 duplicate records in COVID vaccination registrations, for individual facilities. Providers can remove the duplicates, enhance the demographics where they may be out of date or missing, and put in place a proactive system to call out and prevent duplicates moving forward. And the vaccine has a shelf life, correct? So even after segmenting the right patients, how can providers act fast to ensure it is administered? So another best practice is to automate the scheduling for as many vaccination appointments possible. With a tool like Patient Schedule, providers can leverage the demographic data to programmatically push out a notification to a patient’s cell phone via IVR or text message, have them verify their eligibility based on the age or occupation data from Experian, and then allow the patient to book their appointment on the spot for a time that works best with their schedule. On the back end, the Patient Schedule solution syncs with the clinic or mobile vaccination site’s calendar to confirm the appointment, allowing staff the opportunity to tackle other pieces of the COVID vaccination strategy. Anything else you'd like to add? Providers will also want to risk stratify using social determinants of health insight on the individual level. Patients in every wave of vaccine priority present an opportunity for better patient engagement (68% of the US is impacted by at least one social determinant of health hindering them from accessing or prioritizing their care). Many patients will need help adhering to that second dose and knowing that information and those circumstances on the individual level can help providers engage in the best way possible to ensure the vaccine is administered correctly. Interested in learning more about how Experian Health can help supercharge the COVID-19 vaccine management process?

Visits to emergency departments (ED) dropped by 42% in the early months of COVID-19, according to the CDC. In pre-pandemic times, this might have been a positive sign. Two-thirds of ED visits are thought to be avoidable, with emergency care used as a safety net in the absence of access to more appropriate services. Excessive emergency care also comes with a high price, often resulting in a poor patient experience. UnitedHealth Group estimates that the 18 million preventable visits per year cost the health system up to $32 billion annually. Unfortunately, the rapid decrease in ED use during the pandemic isn’t a signal that care management and access challenges have been resolved. Social distancing, stay-at-home orders and fear of being exposed to COVID-19 have prompted patients to avoid seeking care in person altogether. Inevitably, as more individuals either postpone or forego the care they need, ED use will start to creep back up again. For health plans, the worry is a sudden influx of their members returning to emergency departments with more complex care needs arising from delayed treatment. Medical costs could sky-rocket, while gaps in care could reach critical levels as health plans and providers struggle to keep track of ED admissions and readmissions. As health plans look to curb ED utilization in the aftermath of COVID-19, digital tools can provide a valuable lifeline. 4 ways health plans can use digital tools to reduce unnecessary ED visits 1. Take action to engage members before acute episodes occur Proactively involving members in their own care management can help head off unnecessary ED visits before they’re even a possibility. Understanding how the social determinants of health affect a member and how they access care can help health plans tailor their engagement strategies and close gaps in care. Experian Health’s Member Engagement Solutions draw together all the insights needed to connect the dots between emergency visits, social and economic risk factors, and digital care coordination, so health plans can communicate with members in the most effective way. 2. Make it easier for members to access care when they need it Part of the ED visit volume is based on members’ frustration of not being able to access care when they want or need it. Health plans can prevent unnecessary ED visits by sending automated outreach prompts to encourage members to schedule appointments, via interactive voice response or text. A digital scheduling platform can give the member an easy way to book their appointment, without needing to call during office hours. With digital scheduling, health plan member engagement teams and call centers can facilitate member appointment scheduling with the right providers without the cumbersome three-way call. 3. Implement a real-time tracking strategy for ED admissions One of the biggest challenges for health plans is not knowing when members are admitted to the emergency department. A tool such as MemberMatch® can alert health plans of their members’ real-time ED encounters, so they can rally around active episodes of care – potentially avoiding unnecessary, out-of-network admissions and readmissions – and optimize the cost and quality of encounters across the continuum of care post-discharge. Using Experian Health’s leading referential matching system, a member’s care team can be notified via text, portal or email for quick insights that enable better care coordination. 4. Ensure better management of post-discharge follow-up care Every health plan’s checklist for reducing readmissions should include a follow-up strategy when patients have visited the ED. Given that post-ED follow-up for members with chronic conditions is likely to be a STAR measure in the future, plans should prepare their proactive intervention strategy now. USMD WellMed Health System used Experian Health’s Member Utilization Management Solutions for better care coordination for patients within 30 or 90 days of leaving hospital, significantly reducing their readmissions rate. Within just four months, the ROI trends gave them confidence to roll out Care Coordination Manager from USMD clinics to WellMed clinics too. Reducing admissions and readmissions is not about making access to the ED more difficult, but making access to other services, care options, and care management solutions easier. With the right digital solutions, health plans can take action to make this unprecedented transition of care from the ED to other, more cost-effective arenas the ‘new normal’ and put the old model of ED over-utilization in the past. Contact us to learn more about how Experian Health can help health plan reduce unnecessary ED visits.

The rates for closing gaps in care are some of the most widely used, quantitative metrics to measure quality, allocate incentives, and control costs. Unfortunately, health plans face numerous obstacles closing gaps in care, from social determinants of health to inconsistent coordination of care, and don’t always have a care gap closure program in place. Thankfully, digital solutions like web-based scheduling and automated outreach can help health plans jump many of these hurdles while also helping to close gaps in care. Call center schedulingMany health plans are still grappling with the difficulty of three-way scheduling calls between themselves, members and providers. Calls are lengthy and cumbersome as agents dig through binders of provider schedules and scheduling rules to determine and book the right appointment for each member. Members are often put on hold, sometimes more than once, and are much more likely to drop out of the scheduling process entirely when faced with this experience. As a result, these members may face significant care delays, or in some cases miss their necessary follow-up care entirely. With web-based scheduling, member engagement call centers can eliminate three-way calls. Guided search helps to narrow down the right provider for each member and the scheduling platform allows for immediate, on-the-spot appointment selection. Health plans can more efficiently close gaps in care as members can quickly and easily schedule their appointments. This has proven to cut call times in half, and increase scheduling rates by 140%. To learn more, read this case study. Automated OutreachHealth plans typically have a list of individuals to follow up with on a regular (bi-weekly or monthly) basis to book whatever care service is needed to close the gap in care. Now, health plans have the ability to automate this outreach via interactive voice response (IVR) or text message (SMS) while simultaneously enabling members to schedule appointments on-the-spot, either through a link in the text or during the IVR call. The automation improves the member experience with convenient access and helps close more gaps in care – all without a single call center agent. The ultimate combination for closing gaps in careUsed alone, automated outreach and call center scheduling are both effective for closing gaps in care. When used together, health plans can fast track the path to closing gaps in care and further improve efficiencies. Members can first be reached via automated outreach, prompting the individual to schedule an appointment. This allows members the opportunity to self-schedule and essentially self-close their gap in care, without a single live agent phone call. From there, call center agents can pinpoint the members who didn’t schedule as part of the outreach campaign and then call them directly to book the necessary care. We know that despite the flexibility and convenience offered by digital solutions, like automated outreach, there are still individuals who prefer to schedule over the phone and have personal interaction when booking care. The combination of web-based scheduling and automated outreach enables omnichannel access for health plans while helping call center agents focus their attention on the members who need their help most. Contact us to learn more about how Experian Health can help health plans fast track the path to closing gaps in care.

  I attended the Fall 2019 Conference of the National Association of Accountable Care Organizations (NAACOS) in Washington D.C. and wanted to share some insights on how top-performing Accountable Care Organizations (ACOs) are using data to drive improved quality and cost of care. Over the last decade, we’ve seen the number of ACOs surge. Propelled by the shift from volume- to value-based care, over a thousand ACOs operate across the U.S., bringing together groups of physicians, hospitals and other providers with a collective ambition to enhance quality of care, reduce healthcare costs and improve patient outcomes. While some ACOs participating in the Medicare Shared Savings Program have succeeded in improving quality and realizing some savings for the program, the value-based model is still evolving, and results can be mixed. More dramatic and holistic moves will have to be made to convert today’s annual incremental savings of 1 to 2% to make a dent in the estimated annual waste of nearly $389 billion in administrative complexity and another $45 billion due to lack of coordinated care. So what separates the top performers from the rest? At NAACOS last week, speakers confirmed that the most successful ACOs are those that effectively shift care towards primary care physicians (PCPs) and away from acute settings and skilled nursing facilities, implement a process for continuous improvement and adopt a performance-first culture. This is easier said than done. Here’s my top recommendations to help ACOs leverage data-driven insights to lower costs while improving patient outcomes. Offering insights into member utilization of healthcare resources in real-time I recently worked with a client that needed real-time alerts of member activity including admissions, discharges, and Emergency Room (ER) visits. These insights enabled this client to proactively manage active member episodes of care, optimizing the setting and deliver of care for the member’s specific needs. For example, a member was frequently visiting the ER with complications from his Chronic Obstructive Pulmonary Disease (COPD) condition that the client’s care team was managing. This was a needlessly costly way to treat the symptoms. To help get their members the right care at the right time, this client started leveraging automated alerts for their members as they presented within the healthcare continuum. The next time this patient sought treatment in an out-of-network ER for their COPD, their primary care physician (PCP) received an alert about her patient as soon as they registered, before a doctor had even seen him, and certainly before an ER workup converted to an admission. The PCP called the attending ER doctor to share the patient’s history and ensured the ER physician that this patient would receive next-day follow-up care in the PCP’s office. Knowing that follow-up was in place and the patient wasn’t in immediate need of care, the ER physician discharged the patient home. Given that the average cost of an admission can run $22,000, and an outpatient visit less than $500, the savings delivered by this kind of care coordination becomes significant. More importantly, the member experience is much improved in that they get to go home instead of an unnecessary overnight stay in the hospital. And this is just one example—multiply this kind of episode management across all member encounters and consider the improved member quality of life across all attributed lives and the savings for the health plan or ACO in the aggregate. Real-time alerts provide a win-win for both patient and ACO by affording care teams the opportunity to optimize the setting of care for quality and cost. Care coordination for episode management To improve episode outcomes and reduce readmissions, visibility into the compliance of a patient’s post-discharge care plan through the duration of the entire episode is critical, so well-coordinated care requires that clinical context be shared between providers. A frequent barrier to this flow of useful data is that clinicians’ electronic health records (EHRs) aren’t always interoperable. To solve for this, some ACOs are attempting to move all their providers to a single EHR and care management module. However, for some this may not be an option. In these cases, ACOs can opt for Care Coordination Manager: a rules-driven, closed-loop messaging and distributed workflow orchestration platform that enables health plans, ACOs, allied health, and community partners to share and assign care plan requests across a diverse provider community. Care Coordination Manager is vendor-agnostic and able to populate EHRs and care management modules at the point of care with key clinical context. This flow of tasks and content supports high-quality coordination of care and management through transitions of care. Proactively address non-clinical barriers to health for improved patient engagement and health Another characteristic of top-performing ACOs is that they utilize a 360-degree view of their members to address potential barriers that prevent members from engaging in their own healthcare. These SDOH factors can include things like housing or financial instability, food insecurity, limited access to transportation or healthy food options, and other non-clinical factors. Only about 20% of costly health episodes are due to medical factors, so it’s vital for ACOs to incorporate a more comprehensive and actionable understanding of the social needs of the populations they serve. For example, medication adherence is a bigger challenge for a patient who may have difficulty getting to a pharmacy or understanding medication instructions. Identifying and mitigating these risks up front gives the patient a better chance of adhering to their prescribed regimen, which in turn gives them a better chance to stay healthy, ultimately lessening the disease burden and thus the cost of the ACO’s membership while improving the patient’s quality of life. ACOs can take a proactive, preventative approach to addressing these challenges by collecting and analyzing member data and using these insights to tailor interventions. Patient-supplied information through surveys, like PRAPARE, is a good starting point, but surveys can be limited by access to the patient as well as the patient’s ability or willingness to answer honestly. Additionally, unless mapped to structured data such as ICD-10 Z codes, survey data is challenging to scale for broader insights into the ACO’s membership. Instead, consider healthcare consumer data that’s sourced directly from a reliable vendor. Analysis of this demographic, psychographic and behavioral data allows you to flag patients based on need, so you can identify the best way to communicate with members to help them own their healthcare journey. For example, in a recent report by the Department of Health and Human Services’ (DHS) Office of Inspector General (OIG), one ACO described how asking patients with chronic conditions to make a daily call to a care coordinator led to 43% fewer emergency room visits and 47% fewer readmissions. As ACOs grow amidst pressures to take on downside risk and manage costs while improving quality—timely data collection, sharing, analysis and action will continue to provide the foundation of high-quality episode and population health management; along with engaging members and community partners in the healthcare journey. What’s clear from discussions at the NAACOS conference last week is that the opportunity exists to work smarter across many emerging payment models. Could data be the key to unlocking that opportunity? McLain Causey is Director of Product Management at Experian Health.

Last week, I spoke at the technology briefing of a national health plan group to give a presentation on the role of consumer data and patient identity in healthcare and how social determinants of health (SDOH) can help payers improve population health and lower costs. To illustrate the importance of leveraging consumer data for SDOH outcomes, I like to use the example of Vern. Vern is 78 years old, lives alone in a lower income apartment complex and hasn’t attended a wellness check in several years. Last month, he had an unexpected trip to the emergency room (ER) due to heart disease and continues to be readmitted for his condition. But why does he keep getting readmitted? Is it because he can’t afford his prescribed medication? Is he having a difficult time finding transportation? Or could it be that when it comes to healthy eating—buying fresh product on a weekly basis is challenging for him? These are some of the SDOH that could be contributing to Vern’s readmission—not solely his now heart disease. Had his care team known more about Vern, aside from his condition, they could have proactively addressed some of his barriers to care and prevented the ER admissions—saving them from costly care episodes and preventing negative outcomes for Vern. By utilizing SDOH insights, Vern’s care team can help ‘even the playing field’ for him by understanding his non-clinical barriers to health, what key things are driving those barriers, and what makes sense to address them.  All of this, of course, underpinned by an accurate identity (but, let’s talk universal patient identification another day!). With SDOH insights, Vern’s care team could have gotten him to his wellness checks, his condition would have been detected earlier and he would have received the services he needs proactively. This would save countless dollars in repeated readmissions, ER visits and other costs associated with a chronic condition that can’t get better when your members don’t have the luxury of prioritizing health over basic needs. To avoid these missed opportunities, many healthcare organizations are turning to consumer data to understand their patients or members better. Insights on SDOH are transforming the care experience for people like Vern, as well as saving money for patients and the healthcare industry. Here are three ways consumer data is driving improvements in population health and lowering healthcare care costs at the same time: Helping patients lead healthier lives Research shows that clinical care alone is not enough to safeguard a person’s health. Up to 80% of health outcomes are attributable to non-medical factors such as your financial situation, stability of living arrangements, access to transportation and healthful food options, amongst other things. Around 68% of Americans are affected by at least one of these SDOH, which can make prioritizing good health a challenge. When healthcare organizations are more informed of the SDOH impacting their patients or members, they can take steps to help prevent avoidable hospital visits, ED utilization, appointment no-shows and worsened conditions by encouraging and facilitating earlier intervention. For example, 1 in 8 Americans are food insecure.  If care teams are able to recognize when this is an issue for the people they’re caring for—they can look at partnering with community organizations, like a local food bank or meal delivery service, to address gaps in nutrition for better health outcomes. Reducing the financial burden of healthcare expenses In the U.S., healthcare has the world’s largest gross domestic product (GDP) spending (18%).  By helping your members overcome barriers to attending appointments and potentially discovering health issues sooner, the healthcare industry can reduce the costs of healthcare. For example, 3.6 million Americans miss out on medical care due to transportation problems. If care teams knew who they were and what specifically is impacting them ahead of time, they could step in to arrange transportation or offer alternative options, like telemedicine, so problems can be detected earlier. Not only is this better for the patient’s health, it’s better financially too—emergency room visits cost an average of nearly $2,000 while inpatient hospital stays come in at an average of $10,000. When 33% of ER visits are from those experiencing homelessness—the extreme condition of housing instability—it’s imperative that we consider more than a patient’s profile from a claims or clinical data perspective. Offering a better patient experience When healthcare organizations can see each patient as a whole person, they can offer better engagement plans that make prioritizing their health a smaller mountain to climb. Does your patient prefer information by phone, text or email? Do they use their patient portal? Are there other services they might benefit from, that can help improve their health in other ways? Armed with the right data, you can answer these questions and tailor your communications with each patient, ultimately helping them achieve better outcomes. What’s more, when you leverage consumer insights to improve your population health strategies, you’ll also create a better patient experience through improved care coordination, prompt referrals and timely information sharing—making the whole process better for everyone. Translating consumer data into intelligent business decisions With reliable consumer data sourced from Experian—an original-source provider and data steward when it comes to consumer privacy—you can learn more about your patients and make the right care management decisions to address the non-clinical barriers to health impacting the health of your members and your organization. Learn more about how to leverage consumer data to help improve outcomes for your patient population. Mindy Pankoke is a Senior Product Manager for Experian Health

Most healthcare consumers spend only a tiny fraction of their lives in the clinical world of medical appointments and procedures. Where and how they spend the rest of their time has a far bigger impact on their health and well-being. So why are some providers still relying primarily on clinical data to devise their care plans? Clinical data is crucial when it comes to a patient’s diagnosis and treatment options, but it tells you nothing about their ability to stick to a care plan when they get home. How do their living situation and lifestyle habits play into the physician’s treatment recommendations? Consumer data is the missing piece of the healthcare jigsaw. When providers have insights into their patients’ social and economic circumstances, they’re better placed to spot the factors that might hinder access to care, and offer a more holistic, tailored and effective support plan. The predictive power of consumer data Let’s imagine a single mom of two small kids, working two jobs. Her daily life is a race to get everything done on time, give her children what they need and still make ends meet within her weekly budget. When a reminder for her annual wellness appointment flashes up on her phone, she adds it to her mental to-do list. But by the time the appointment comes around, the stress of taking time off work and scraping together the cash for gas or bus fare means she puts it off. She doesn’t go. Six months later, she ends up in the emergency room with symptoms of a serious illness. Had her provider known about the barriers in advance, they could have supported her to get to her appointment and discover her illness sooner. As Dr. David Berg, co-founder of Redirect Health says, “the most important part of getting good results is not the knowledge of the doctors, not the treatment, not the drug. It’s the logistics, the social support, the ability to arrange babysitting.” Consumer data, such as car ownership, employment status, income level and family information can give you these insights early enough to take action. You’ll know whether your patients can get to their appointments easily, whether they can afford childcare, and a whole host of other factors that might affect their ability to stick to a care plan. And once you know those things, you can offer tailored support to give them the best chance of success. How to gather non-clinical insights According to PwC, around 78% of providers lack the data to identify patients’ social needs. Many have basic demographic information on their patient populations, but are missing the more sophisticated insights that could help them better support patients. It doesn’t have to be complicated, but there are a few considerations healthcare providers should vet as they gather and use consumer data to help drive care plan compliance: Evaluate the pros and cons of patient surveys The obvious way to find out more about your patients’ needs is to ask them directly. A survey at the point of registration can help you understand what barriers may prevent them from attending appointments, taking prescriptions or following other medical advice. However, surveys can be time-consuming and expensive to administer, and recording answers by hand can lead to errors. How a patient interprets the questions and how your team interprets the answers may affect the usefulness of the survey data. And a patient’s circumstances may change between completing the survey and trying to follow the care plan. This approach also only includes patients who manage to attend an appointment in the first place. Those without access to care such as the mom in the example above, would be omitted from the survey, so you would miss out on discovering how to help them. Tap data vendors to deepen your consumer insights A third-party data vendor can give you access to data on your patient population’s income, occupations, length of residence and other social and economic circumstances. When this data is packaged up for your care managers, it can be used to inform proactive, preventative conversations with your patients, to solve any non-clinical gaps in care. It’s more cost-effective than patient surveys and removes the risk of personal bias and interpretation. Ensuring the reliability and integrity of your data vendor can be a challenge. Data brokers often use consumer data collected in retail and other industries, which may not be completely relevant to your activities or collected in a way that meets the requirements for use in healthcare settings. It’s crucial to be able to verify the source of the data and confirm that individuals were told how their data would be used and given the choice to opt out. Always ask your vendor if they are an “original source compiler." Working with a data vendor in the health space, such as Experian Health, can help avoid these pitfalls, as they will have expertise in the appropriate use of consumer data in healthcare. Understand permissible use of consumer data to stay compliant To use consumer data successfully, you must have confidence in both its accuracy and your ability to safeguard patient privacy. For example, are your data collection processes compliant with the General Data Protection Regulation (GDPR) and the California Consumer Privacy Act 2018 (CCPA)? Working with a data management partner who collects data directly from consumers means you can verify that all privacy requirements and opt-outs are in place. They’ll also help you scrutinize hundreds of public and proprietary data sources, so you use only the most relevant, up-to-date data to inform your decision-making. By evaluating and understanding these three areas, you’ll be able to leverage consumer data to tailor your patient engagement and support and make it easier for your patients to comply with their care plan. The more you are able to see and treat each patient as a whole, individual person, the better their health outcomes are likely to be. Consumer data lets you do that.

When nearly 80% of health outcomes can be traced to non-medical social and economic factors, we need to look beyond the medical world to improve them. Perhaps a lack of transportation prevents a patient from attending an appointment, or juggling two jobs makes it difficult to collect a prescription. Maybe a patient’s care plan calls for lifestyle changes that are simply unrealistic in their current circumstances. When life gets in the way, there’s only so much the physician can do. Creating and maintaining a healthy, happy population truly takes a village – from your clinical team to the community resources around your organization. For many healthcare providers, there’s probably a lot more going in their ‘village’ than they realize. Do you know who your patients really are, beyond their lab tests? Do you know what nearby services are at your disposal to help you offer the best possible care? Knowing your patients and your health improvement ‘village’ means you can offer a personalized experience to your patients, to improve their care management and ultimately help them achieve better health outcomes. 3 ways to tailor care management for better patient outcomes Let’s imagine two patients, who have both recently broken their wrists and been treated in your facility. Gene is 71 years old and David is 34. From the clinical perspective, it might be reasonable to assume that David, being younger, should simply receive discharge directions and a time for a follow-up appointment, and be on his way. Gene, being older, might require a series of follow-ups. But thinking of the village analogy, is there more you could learn about Gene and David to engage with them in a way that’s tailored to their specific needs? Here are three ways social determinants of health data can help you do just that. Use non-clinical data to get to know your patients Non-clinical data can help you learn more about your patients and the lifestyle factors that might affect their health. This allows you to address issues like excessive healthcare utilization, preventable readmissions, no-shows and low patient engagement. Surveys at the point of registration are one way to get fresh socio-economic insights. But these can be cumbersome to implement, and findings can be limited by the nature of the questions. You might also review geographical and community-level data to discover your local population’s income, housing situation, employment status, and so on. This can be useful for population-level care planning, but it’s not patient-specific. A better way is to analyze securely collected marketing data for more specific and accurate information. This could tell you that Gene’s living situation actually has a minimal impact on his ability to access care, healthy food and reliable housing. Additional follow up appointments may still be appropriate, but perhaps less urgent. By contrast, you might find that David has limited access to care because he lives alone and far from public transportation. His lifestyle suggests he’d be unlikely to prioritize getting gas to drive to a follow-up appointment over getting to work. In this situation, a remote health appointment might be the better plan. Know your community resources Once you know what David and Gene might need, you can point them towards any appropriate community resources to increase their chances of a quick recovery. Of course, to do this, you need to know what and where these resources are. For example, can you link David to an appropriate home health or telehealth program, or is there a non-emergency medical transportation service in your area to get him to his appointments on time? If Gene needed support to follow a healthier diet, would a local food bank be available? If either had an unstable living situation, would you know which local or national housing coalitions could help put healthcare within reach? Tools such as NowPow, Aunt Bertha and Healthify exist to connect the dots between patients, providers and wider community resources, and close the gap in holistic care. Be proactive and preventative by holding conversations with your care teams prior to seeing patients When you have reliable insights and data analytics to anticipate what patients like David and Gene might need, you can work with your care teams to develop a shortlist of options ahead of time. In this way, they’ll have realistic and ready-to-use solutions to give the patient right there and then. To truly get the most out of social determinant of health data, your care coordinators need easily digestible patient profiles which they can understand and use in a split-second. Bringing the whole patient into the care plan Healthcare is growing more and more sophisticated in identifying ways to better manage care for patients by using data science and machine learning to predict health events. These insights help coordinate care plans that are preventative and proactive. Essentially, it’s about knowing your patients as well as possible, and being able to quickly match them to the services they need. ⁠— Discover how we can help you leverage social determinants of health data for your patient population, so you can bring in the whole ‘village’ of resources to support them on their healthcare journey.

It’s a puzzle many healthcare providers are still working to solve: when over 80% of health outcomes are influenced by non-medical factors, how can health systems help their patients achieve better outcomes? From affording time off work so they can attend an appointment, to accessing healthy food, childcare or transport, your patients’ ability to engage with and benefit from health services can be heavily influenced by a host of social and economic dynamics Understanding these social determinants of health (SDOH) gives you a more complete picture of your patients’ health and life circumstances. You can anticipate their needs, coordinate their care more effectively, and ultimately give them a better healthcare experience. What’s more, harnessing the right data on SDOH leads to smarter investment and operational decisions, yielding advantages for your health system as a whole. That’s why many providers are starting to use non-medical consumer data in their care management planning. Here we look at some of the top use cases for SDOH data. 5 top use cases for data on social determinants of health     Reduce missed appointments No-shows cost providers an average of $200 each (plus a lot of wasted physician time). Often these are down to lack of access to transportation or childcare. SDOH data can help you anticipate where these challenges might occur, so you can offer additional services like a free shuttle bus or crèche. You’ll make the experience a little easier for the patient, and potentially prevent an unchecked health issue from becoming something more serious.     Save costs from preventable health events Unfortunately, life circumstances can lead to many people using health services in a way that could be avoided. Missed appointments or difficulty following a care plan can lead to escalating medical issues, entailing more treatment and readmissions. Patients might also fall back on emergency services because they can’t easily access appropriate alternatives. SDOH data helps you understand the circumstances that might lead to this kind of patient behavior. For example, if you can spot patients who may be likely to dial 911 because they have no other way to get to the health services they need, you can offer alternatives that avoid an unnecessary visit to the ED. This could help you save up to $2000 per Emergency Department visit and around $10,000 for each hospital stay (which often can’t be fully reimbursed if the patient ends up being readmitted).     Increase care plan compliance A patient’s living situation can often determine whether or not they’ll be able to stick to their care plan. For example, specific dietary advice can be a real challenge for a diabetic patient if they have a limited food budget, lack of time to shop and prepare food, or a plain lack of options of where to buy it. An SDOH needs assessment can flag this in advance so clinicians can help patients find a plan that will work for them. Similarly, pharmacies might use consumer data to help minimize abandoned prescriptions or situations where a patient fails to follow dosage directions, which is estimated to cost the industry $290 billion per year.     Save administrative and clinical time Analyzing consumer data can help your operations run more efficiently, which benefits your patients through well-coordinated care, timely information sharing and prompt referrals. Many providers are taking advantage of automated solutions for leveraging SDOH data, saving massive amounts of administrative time for care managers by pre-populating patient data and automating SDOH needs assessments. Consumer insights solutions like Experian Health’s ConsumerView analytics can optimize operational efficiencies and ensure your care managers use their time well.     Investing in relevant community health programs One of the most impactful use cases for SDOH data is to gain a richer understanding of your member base, so you can invest in the most relevant community health programs. For example, a 2018 pilot project by Atrium Health in North Carolina screened for food insecurity in older patients who may have been at risk of readmission. Emergency food services were provided where needed, and as a result, readmissions dropped by 60%. Your purchasing power can also be a force for change. The Cleveland Clinic outsourced its laundry service to Evergreen Cooperative Laundry, a local collaborative working to combat poverty. Ralph Turner, executive director of patient support services at the Cleveland Clinic says: “Establishing the foundation for people to stabilize their incomes and become part owners in a business… in itself generates health and wellbeing in our community.” Leveraging consumer data to improve patient outcomes These examples show some of the varied ways screening for social determinants of health can open the door to understanding your patients and creating truly person-centered care services. Who knows what opportunities are hidden in the SDOH data for your patient population? Are there gaps in your data? Could you combine different data sets for a fuller picture? What exactly is your consumer data telling you, and how do you turn it into meaningful management decisions? At Experian Health, we have comprehensive data assets and analytics platforms to help you answer these questions and more, and leverage consumer data most effectively.

What if you could flag patients who are at risk of readmission? What if you could anticipate missed appointments or know ahead of time that someone is going to face challenges with their care plan? This knowledge could help you improve patient outcomes, streamline staff workflows and improve your bottom line. So how can you get this non-medical information and use it to improve treatment outcomes? A person’s circumstances can help us understand potential challenges in access to care to predict their behaviors More than 80% of health outcomes are unrelated to medical care. Instead, they are attributable to outside social and economic forces, such as housing, education, unemployment, low income, transportation, access to green space, loneliness, inequality and other non-medical factors. These social determinants of health (SDOH) are the living and working conditions that come together in just the right combination to either promote or a limit a person’s health and wellbeing. As a healthcare professional, you’re no doubt aware that people struggling with financial or life circumstances have a more difficult time focusing on their health and subsequently face more urgent hardships. And it isn’t just the patients who suffer. It has a negative impact on the entire healthcare ecosystem. Why providers should care about social determinants of health When patients struggle to access healthcare services, they’re less likely to follow treatment plans or adhere to follow-up visits. They’re more likely to need to come back with more serious conditions that could have been detected earlier, had they felt equipped to follow the care plan. Not only is this worrying for the patient, but it also leads to excessive service utilization that is costly for providers. Missed appointments are estimated to cost the US healthcare system a massive $150 billion, while each unused 60-minute slot costs an average of $200. And that’s not to mention the opportunity cost of equipment and rooms sitting idle, and all those wasted hours of billable physician time. The shift to value-based care puts more pressure on providers to improve outcomes. But how can they do that when those outcomes are partially determined by factors beyond their control? Considering that 68% of patients have at least one social determinant challenge, the only sensible move is to bring solving for SDOH to the forefront of care planning. “No patient wants to skip appointments and dial 911 as their only reliable means to get the care they need,” said Karly Rowe, Experian Health vice president of product management. “We want to level the playing field by helping providers identify and solve for these socio-economic challenges that make it hard for some patients to get the care they need. SDOH has the ability to improve outcomes, lower costs and increase patient satisfaction, removing the socio-economic obstacles hindering healthcare.” An example of providers and payers collaborating to solve for social determinants of health is the Aligning for Health coalition, which in 2016 referred 33,000 patients to community initiatives. Andy Friedell, a senior vice president at Maxim Healthcare Services said of the program: “We are prioritizing community-based care and social determinant solutions for our patients and clients. In fact, we have effectively used these tools to help reduce readmissions by over 65% for high-risk patients.” How can social determinant data improve outcomes? Let’s look at two examples of how healthcare providers might analyze social determinants to help improve care management. 1. Reducing appointment no-shows For many patients, a lack of transportation is the main barrier to compliance. How do they get to an appointment or procedure if they don’t have a car, don’t live in an area well served by public transport, and can’t afford a cab? Looking at vehicle registration data and public transport services in the area would be one way for a provider to gauge access to care. But does that give the full story? Even if they can find transport, are they juggling two jobs? Do they need childcare? By synthesizing data on transportation, family arrangements, average incomes, and more, providers can anticipate the propensity of someone being unable to access care, and offer solutions such as a free hospital bus service or crèche facility. 2. Preventing escalated health conditions Understanding social determinants is not about identifying unhealthy behavior. For example, a provider might see poor health and point to poor diet. But a patient’s poor diet may not simply result from poor choices. A provider who’s aware of the potential impact of social determinants might consider the propensity of food insecurity – maybe the patient doesn’t have access to healthy food? However, putting the patient at the center and truly understanding social determinants means thinking beyond the ‘food desert’ explanation. Even where healthy food is available, the ability to eat it might be limited by lack of time to cook it, or money to buy it. The provider must adjust their lens and understand how a stressful work schedule, chaotic household and readily available cheap food converge to make it virtually impossible for the patient to even think about putting their health first with a healthy meal. As a result, a patient who could have been identified early on with symptoms indicating the onset of diabetes, for example, instead has their diagnosis delayed because they can’t get to an appointment, while their condition worsens due to their unhealthy diet. Instead of offering dietary advice or signposting to a wholesome supermarket, the provider might choose to work with a registered dietician nutritionist, direct patients to community resources, participate in community partnerships, or even engage with local planning departments and commercial developers. When you understand what drives your patients and recognize the real barriers preventing them from prioritizing or accessing healthcare, you can proactively identify opportunities to solve them. 3. Using the right data to understand and solve for social determinants of health Better care management and improved health outcomes start with understanding the whole patient and the social determinants impacting their life, and then turning those insights into actions. For providers to be proactive, preventative and patient-friendly, they need to know the patient’s socioeconomic background before they enter the room. They must have an idea of what that conversation should look like before they even say hello, and know which SDOH-related programs might be relevant to this patient. Analytics platforms can help leverage wider consumer data sets to spot patterns that affect operational efficiencies so providers can offer more patient-centered care. Of course, if you’re using consumer data, you must have confidence both in its accuracy and in your ability to safeguard consumer privacy. Both can be achieved if you work with a data management partner who can collect data from consumers at scale, with solutions that check all the privacy boxes necessary to allow this data to be used in a healthcare setting. Identity management protocols can guarantee robust patient-matching and cross-system interoperability. So if you weren’t already thinking about what social determinants of health mean for your organization, perhaps think about what you could do now to incorporate a solution that tells you what patients need, provides the right amount of context to understand what external factors might be causing or affecting that need, and then solve for it at the point of care. — The solution exists to help you. You could have the power to identify and solve for social determinants at your fingertips.