Every time I pitch an initiative to pharma I am asked about the ROI. Although I have been able to develop and implement initiatives that have supported patients, increased sales, increased the company’s access to customers at all levels – they still want an ROI. I have done programs similar to the one below. The pharmaceutical company invested $3.4MM, the Community Health Partnership returned $406MM, within the first year, changed behavior for both patients and physicians, increased access to customers at every level. Here is an example of an organization producing ROI while supporting patients. This article was originally published on the Patient Engagement HIT website on October 14, 2020.

Just my thoughts,

Dyan Bryson

At Healthy Alliance IPA, outlining return on investment for social determinants of health is key to meeting patient needs and avoiding suffering.

By Sara Heath

– As a family medicine doctor, Jacob Reider, MD, the former Deputy National Coordinator for Health IT, has spent most of his career focusing on disease treatment. From medical school to residency, nearly 100 percent of his training was focused on how to treat disease. But times are changing, according to Reider, and it’s high time healthcare focus on the social determinants of health.

“If you think about it from a societal perspective, that’s backwards,” Reider told PatientEngagementHIT in an interview “We shouldn’t wait for people to have diseases and then treat them. We should prevent illness. We should maintain health. And yet very little of where we see dollars being invested in our community is going to health. They’re actually going to care.”

But in an era of value-based care, Reider, like other providers across the country, has recognized that the focus on sick care, the interventions clinicians do after a patient falls dangerously ill, is falling short. This type of healthcare is expensive and doesn’t promote good quality of life for patients.

Instead, the healthcare industry is increasingly embracing interventions that address the social determinants of health. Disrupting these upstream factors that affect an individual’s ability to achieve and maintain health is proving an attractive option for clinicians and healthcare leaders working to cut costs and promote optimal outcomes.

In 2018, healthcare consulting firm Leavitt Partners reported that nearly three-quarters of medical providers agree the social determinants of health are integral to overall wellness. In the time since that report, anecdotal evidence suggests even further industry consensus. Nearly everyone has acknowledged that programs that ameliorate the effects of social risk factors can improve the healthcare system.

READ MORE: Why Community Health Partnership is Key to Drive Health Equity

But from there, the industry hasn’t progressed much further.

“The core challenges that we’re having are actually focused on how to demonstrate the return on investments that needs investments,” Reider explained. “Exactly which dollars should we spend, and exactly which programs should we invest in?”

That’s some of the work Reider is engaged in right now. As CEO of the Alliance for Better Health, parent company for Healthy Alliance IPA, Reider and his team are bringing together community-based organizations in upstate New York so they can build better efficiencies and establish more consistent business operations. Perhaps most important, Healthy Alliance IPA also works to contract with at-risk care delivery organizations and health plans to address the social determinants of health.

“The hypothesis, the guiding thesis of our organization, is that if we, as a community, invest in addressing social determinants of health, we help people remain and stay healthy or become healthy, rather than do what traditionally medicine has done, which is to address illness,” Reider outlined.

Healthy Alliance IPA has targeted that work through a number of pilot projects, working to pin down return on investment for certain interventions and then selling those services to health plans. In short, Healthy Alliance IPA is working to create a public utility.

READ MORE: Using Social Determinants of Health in Patient-Centered Care

One of those utilities, which required considerable iteration, was a focus on transportation to care.

Reider and his team had heard from numerous stakeholders that lack of transportation was a leading barrier to optimal health. Patients were accessing the emergency department for low-urgency needs, largely because calling 911 was easier than getting a ride. In other cases, patients neglected their medication plans because they couldn’t get to the pharmacy and their pharmacist didn’t do home deliveries.

“So both of these are anecdotes to prompted us to think, ‘well, gosh. If we just called somebody a Lyft or an Uber, got them to where they needed to get to, then problem solved, right?’”

That’s exactly what Healthy Alliance IPA did. Reider and his team organized rides for a number of non-medical needs (Medicaid already covers transportation for medical needs), like going to the grocery store or visiting social services or taking a job interview.

“We discovered through that pilot that there are some kinds of rides that do seem to be correlated with a reduction in preventable use of the emergency departments,” Reider reported. “For example, it seems like there’s some data to support that rides to Narcotics Anonymous meetings are correlated with reduction in preventable emergency departments.”

READ MORE: New Tool Assesses ROI for Community Health, SDOH Interventions

This is a service Healthy Alliance IPA can market to health payers. If that payer has a high emergency department utilization rate as well as a big population that uses narcotics, there might be some return on investment here, Reider stated.

Healthy Alliance IPA is focusing on other key social determinants of health, too.

“Food assistance is certainly a big part of what we’ve been doing, working with local food pantries,” Reider stated.

Healthy Alliance IPA set up its Food Farmacy program to help patients stick to a diet that might help them manage an illness for which they had been hospitalized. Understanding some patients have trouble getting to a grocery store that sells nutritious foods, the Food Farmacy program offers a prescription for healthy meals and teaches patients how to incorporate those meals into their lifestyles.

“The Food Farmacies set folks up for some period of time of food assistance, including food delivery, and then a nutritional program that gets them in a sustainable and ideally more healthy habit of feeding themselves and their family,” Reider explained.

Healthy Alliance IPA has also worked to mitigate risk for individuals who are homeless and who have been discharged recently from the hospital. Most of the time, these patients have nowhere to go. Most homeless shelters do not enlist medical providers, meaning anyone with medical needs are not allowed into the shelter.

This lands many sick individuals who are homeless back on the street, which inevitably leads to hospital readmissions.

“We set up a respite program with one of the local homeless shelters in a wing of a hospital that had shut down most of their acute care services,” Reider said. “We staffed that wing with both a traditional homeless shelter and also nurses. It prevented folks from being readmitted.”

Understanding how different interventions can prove a return on investment is a critical step forward, but there’s still further to go.

“This work is self-evident. It should work. And yet, we’re not at a place yet where there are means of paying for these kinds of activities predictably,” Reider pointed out.

This comes even as the healthcare industry increasingly sees the social determinants of health at play. In addition to the focus medicine has given to community health as part of its transition to value-based care, the COVID-19 pandemic has made this an urgent issue.

“The next couple of years are going to be very interesting, especially in the context of COVID-19, we have more poor people now, than we have had for probably decades,” Reider said. “Lots of our communities are really suffering. We’re only starting to see the tip of the iceberg of what this jumped in unemployment is causing.”

At the end of the day, this is going to be a societal and philosophical question for not just healthcare, but the nation at large. As Reider said, these social determinants of health interventions are akin to public utilities, and this shared cost might be essential to improving the lives of everyone.

“We are helping people avoid suffering that traditional models of care would have permitted,” Reider concluded. “We [in healthcare] wait for people to suffer and ask for help or need help. This way, we are preventing that hardship, and that is a big part of what motivates most of our team to come to work every day, to do what we do.”


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