Approaches & Tech to Activate Patients

A December, 2019 interview with Humana’s CMO highlighted the major shift driven by value-based reform. “I remember having this belief that my role was to recognize what the patient’s diagnosis was and give a prescription for insulin. And then I thought I’d done a good job,” said Dr. Roy Beveridge.

He goes on, “The more complicated part is explaining what their disease is and helping them take their medicine.”

He pointed out that “the recognition of social determinant health (SDOH) issues is fundamentally linked to population health” and to the success of value-based care. He called this the “democratizing of healthcare.”

A February 2018 survey of health plans indicated that 80 percent believe that addressing SDOH will be a “key way to improve their population health programs.”

Despite the underuse of technology by people with chronic illness, technologies that can reach people where they are, day in and day out, are key to making in-the-moment connections to support people in meaningful ways. Meaningful connections, education and resources are at the crux of addressing social determinants of health for everyone.

Below, we share some innovative programs that are using digital technology to improve health and access by addressing SDOH.

At SDLC Partners, we are working with healthcare leaders to create technologies that accelerate and scale value-based care programs. View the case studies of our healthcare innovations and client successes.

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Literacy & Access:

Medicaid in Pennsylvania offers one platform to apply for multiple programs, including, Medicaid, the Children’s Health Insurance Program (CHIP), and the health insurance marketplace, as well as programs that administer food stamps, school lunches, child care assistance, and other benefits.

88% of healthcare organizations screen populations for SDOH, but 30% face challenges with lack of supportive services
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Lyft’s new partnership with Allscripts will further integrate its service into EHRs. It makes transportation services available to 45,000 physician practices, 180,000 physicians and 2,500 hospitals that use Allscripts EHR. Their goal is to cut by half the 3.65 million Americans who miss medical appointments due to transportation issues.

70 percent of health and well-being are affected by factors that relate to social determinants of health, as indicated by the Kaiser Family Foundation.
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Behavioral Health:

Telehealth is another digital technology, enabling care that requires no transportation and speeds access. Intermountain Healthcare’s virtual hospital incorporates 35 telehealth programs, including one that provides crises evaluation to outlying areas with high suicide rates. “Patients receive that crisis evaluation in less than an hour, and if the crisis worker recommends inpatient treatment they assist in placing the patient.” The health system is looking into placing telehealth kiosks in places like schools, homeless shelters, community centers and jails.

52% of adults living with two or more chronic diseases go online.

Pew Research
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Bergen County, N.J., where officials recently certified their jurisdiction as first in the nation to end chronic homelessness. “The county began using biometric devices — fingerprint scanners, essentially — to collect information daily about who comes in for things like computer use, meals, showers, laundry and the phone. These devices have been helpful tracking efforts to help both the homeless and those at risk for becoming homeless.” When housing becomes available, they use the data to prioritize candidates.

West Sacramento, C.A’s Police Department is using a tech platform called Outreach Grid, which the agency helped create by collaborating with developers. “With Outreach Grid, case workers and other public servants in West Sacramento can now map homeless encampments, consolidate client info from multiple agencies into one platform and customize intake forms based on needs. Other cities across the country have developed similar tech-based improvements to their homelessness outreach efforts, while at the same time almost universally agreeing that data collection, logging and sharing are long-standing problems.”

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A recent article in JAMA highlighted the issue of language and how it correlates to medication adherence in diabetics. Despite utilization of translation services provided by an interpreter or the clinician, adherence was lower in the non-English speaking group than either the English-speaking Latino or white patient groups. With technology, issues such as this can be far more easily addressed and adjusted to constantly better meet the needs of patients – regardless of language.

“98% percent of my patients are below poverty level; 70% run out of money by the month’s end; 65% run out of food; 60% are concerned about mental health of caregiver of their children. As a healthcare organization, sometimes we have no way to meet these social needs that directly impact health outcomes.”

Pediatrician, Oakland, CA
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Food Scarcity:

Blue Cross Blue Shield Foundation of California and the Center for Care Innovations is leading a program in Sonoma County, California using a mobile/secure text platform, connecting members to information regarding food pantries, housing and substance abuse centers. The program is reported to have decreased ER visits by 60 percent.

Food Access: Amazon, along with six other retailers, is participating in a two-year pilot program in which they will accept SNAP benefits as payment for online grocery orders in three states, discounting Prime membership to provide home delivery.

2/3 of hospital EHRs do not screen for social and behavioral needs.
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OneCare Vermont’s ACO is using a platform that connects practice-based coordinators throughout the state to community health workers in the member’s home. Through a multi-channel approach, teams within brick-and-mortar care environments can coordinate care and communicate with patients and their in-home care navigators.

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We’re at the heart of where healthcare strategy, operations and technology meet and scale for success in the payer and provider world. Contact us to speak with our healthcare experts, contact us or call 412.251.0848.



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