Healthcare, including behavioral health and IDD, is rapidly shifting to value-based payment (VBP) reimbursement models, which align care with outcomes instead of fee-for-service. Delivering quality care at an optimal cost is key to VBP. For counties, that means demonstrating quality outcomes to taxpayers in connection with a voted tax levy on grant applications or to other sources of funding or reimbursement.
A wide range of analytics are necessary to measure and report provider performance. In order for your organization to be successful amid the new payment model, it’s vital to reevaluate your care management and service delivery strategy based on performance data.
One key element in this process is understanding and addressing the behavioral, social and environmental factors that impact the populations you serve, which are often called the “social determinants of health.” The World Health Organization (WHO) defines social determinants of health as “the conditions in which people are born, grow, live, work and age.” Examples include education, housing, food, social support networks, socioeconomic status and ability to obtain adequate healthcare.
According to the Centers for Disease Control and Prevention (CDC), the social determinants of health have a bigger impact on outcomes compared to the actual delivery of health services. A January 2017 policy brief from The National Advisory Committee on Rural Health and Human Services found that underserved populations carry the burden of hidden costs and historical trauma correlated with deteriorating health status. Social determinants of health are a reminder that the sum total of the nation’s health is more than that actual dollars spend on healthcare.
It’s crucial that county behavioral health and IDD providers have access to actionable analytics and data related to social determinants.
Physical health, mental health and social determinants data are integrated within electronic health record (EHR) technology. Certain trends and data markers allow providers to identify potential risk factors prior to meeting an individual face-to-face. For instance, providers can identify persons who pose a risk for readmission within 30 days, for which providers are often penalized. Using this data, allows the provider to focus on ways to prolong a person’s health and proactively intervene with alternative treatments or care plans.
Another example of the importance of social determinants is in the context of someone’s complete health history. If a person doesn’t have the financial means to adhere to a treatment plan or reliable transportation to appointments, they are at greater risk for an escalating health issue or other adverse effects.
Each example shows how important it is for providers to understand their population and establish a workflow that caters to anticipated challenges. When social determinants are considered at the point of care, appropriate intervention can reduce readmission rates, negative outcomes and unnecessary expenses.
Netsmart Executive Vice President Kevin Scalia and Senior Associate at OPEN MINDS Deb Adler collaborated to create the “Less Pain, More Gain: Leading a Cost-Saving Plan with Provider-Driven Outcomes” webinar. If you want to learn more about implementation strategies to cut costs and increase efficiency by leveraging social determinants of health data, check out the full webinar here.