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Why Social Determinants of Health Are a Critical Factor for Preventing Member Risk Escalation in the Value-Based Care Equation

June 27, 2022Kim GlenManaged Healthcare ExecutiveRisk Management,Social Determinants of Health (SDOH)

The role of homecare providers is central as the industry transitions to value-based care. Rather than reimbursing providers based on the quantity of services delivered, value-based care rewards providers for the quality of their services and their impact on member outcomes.

However, when considering factors that impact the health of a member receiving care in the home, the quality of care that a provider delivers is not the only factor in ensuring a member achieves optimal results. Likewise, clinical factors, including access to medical care and the quality of that care, also can only make so much of an impact. What’s truly most influential are social determinants of health (SDOH), which influence more than 80% of health outcomes. SDOH include social and economic factors, including level of education, employment, income, community safety, family and social support; health behaviors, such as tobacco, alcohol and drug use, diet and exercise; and physical environment, including air and water quality, housing, transportation, and access to healthy food.

For providers to effectively deliver value-based care and proactively minimize health risks, they need to understand how SDOH are impacting their members. But getting that data and assessing it to provide optimal care can present a challenge. The first hurdle is often the member themselves. Many are not comfortable providing sensitive information, or may not be completely upfront about their lifestyle, which can make it difficult for providers to see the full picture. Members may also have concerns about how this personal information may be used.

Full Article

: Risk, SDOH

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