According to researchers, only 10 to 20 percent of an individual's health outcomes are driven by medical care alone. The remaining 80 to 90 percent are driven by social determinants of health (SDoH), or the environmental and social factors at play in our lives and our communities. And addressing these factors presents possibly the most powerful way to support both health equity, preventable events and overutilization.
It boils down to a combination of data that provides both a 360 view of a population’s health from a clinical perspective and a snapshot of potential risk based on social factors. Based on these findings, providers and/or payers can connect individuals with existing community resources that proactively address the factors which so heavily predicate health outcomes. And it’s an area where 3M Health Information Systems (HIS) is going all in.
This year, 3M launched the Social Determinants of Health Analytics (SDoH) technology platform that pairs 3M™ Clinical Risk Groups (CRG) with social risk data. This powerful combination of data allows payers and providers to identify at-risk patient populations from both a medical and social perspective, supplying a clearer path to more effective, and long-lasting, assistance. Simply put, integrating clinical and social risk allows providers and plans to more effectively care for members.
As previously stated, the vast majority of an individual’s overall health is determined by social factors. Thus, achieving health equity can no longer end when the patient leaves a provider’s office. 3M SDoH Analytics provides the actionable data needed to connect patients with community-based organizations (CBOs) that work to end barriers to care such as health literacy, reliable transportation and access to fresh fruits and vegetables.
A recent case study (PDF, 91.11 KB) of Community Care Plan (CCP), a provider-sponsored health plan in Florida, demonstrates an important use case for incorporating SDoH with CRGs to proactively address potentially preventable events long-term. This data allowed CCP to build a healthier community by answering these questions:
Incorporating social risk data, SDoH data is the first step in promoting and sustaining improved health outcomes for the broader community. While it’s an investment that can take years see improvements, trackable key performance indicators are built into the program which allow users to demonstrate ROI. And CCP has already achieved some impressive results:
“Community care Plan’s member-focused, collaborative care management model has strengthened member engagement by having the ability to integrate social risk with other care coordination activities,” said Miguel Venereo, M.D., chief medical officer at CCP.
By leveraging analytics based on clinical and social risk, payers can enhance the connection between high-risk patients, their proactive care management and the CBOs that can best support them.
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