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Social determinants and data analytics may be the keys to a better health plan strategy

Providing positive patient outcomes is – and always will be – the primary goal of the health care industry. One way to improve outcomes is to use the wealth of data that exists on customer expectations, social patterns and trends. New data and technology are reshaping how doctors treat patients and how health plans connect with and serve their members.

The transformative nature of how we plan, deliver, and pay for care was reinforced recently during the America’s Health Insurance Plans (AHIP) Medicare conference in Washington, DC. Speakers touched on a range of salient industry and consumer issues. Two key themes — social determinants of health and data analytics — arose frequently during the conference. Health plans need to evolve their strategies using these insights to better support member needs and grow their businesses.

Social determinants seems to be the topic du jour in the industry these days, and with good reason. According to the Gallup Well-Being Index, 80 percent of health outcomes are determined by environmental and social factors. Socioeconomic status, family support, location, and even availability of transportation are factoring into how plans are creating new policies – particularly when it comes to providing optimal service to Medicare members. Addressing social determinants presents opportunities for the entire system. For health plans, this means developing more effective, responsive strategies to focus on broader social and non-medical issues.

Some Medicare Advantage (MA) plans have found ways to engage with members directly and address some of the root causes of poor health. For example, Bronx-Lebanon Hospital Center partnered with the American Diabetes Association and a plan focused on Medicare and Medicaid to improve the health of residents of four public housing complexes in South Bronx. To do this, they provided healthy and fresh foods, exercise programs, information on healthy living and managing chronic disease, and youth engagement efforts. In developing this collaboration, Healthfirst discovered that health plans have a role to play in helping bridge the trust gap for people who feel disenfranchised by the health care delivery system. To that end, the organization has prioritized care management, “feet on the street,” people, processes and tools strategies to support not only their members, but also the providers in their network.

Plans can use data analytics to understand the makeup of patient populations and their social needs and then use this information to provide better care. In fact, seemingly half of conference attendees were not health plans, but rather the suite of vendors and applications at plans’ disposal discussing how to use analytics to optimize MA plan performance, enhance star ratings, or to identify and manage specific patient populations. Many companies today are focused on supporting health plans with analytics strategies – the question becomes how to find the right partners in the sea of vendors, technologies, and solutions.

Plans also should engage with consumers to activate them to take their health care into their own hands. At the conference, we heard a lot about how retail strategies are influencing our industry. Can retail health be marketed and transacted the way Amazon interacts with its customers on the purchase of consumer goods and services? Perhaps, but health care is different and one that has a higher mission. Retail strategies may, however, prove to be effective at reaching consumers in a personal way – providing more convenient care to best serve their population and community. And, with the wealth of data at retailers’ fingertips, plans may begin to more specifically target and understand populations.

Retail strategies are attractive, but broad adoption won’t likely happen overnight. Integrating technology and mobile services into health care may be a tough sell for the Medicare population. Historically, older consumers have been less likely to use technology and mobile apps for their health care information. But, that may be changing given forthcoming Deloitte research which shows younger Baby Boomers may be more open to technology. Specifically, as reported in a recent paper by Deloitte University Press, Will patients and caregivers embrace technology-enabled health care?, among generations, seniors show the highest interest in using sensors but lower interest in telemedicine.

I left the conference wondering how to take these lessons about social determinants and data analytics and make them work for plans and the Medicare populations they serve. Ultimately, it’s about the power of the consumer, the tools and resources that can harness that power, and the partnerships that can facilitate positive change.


Author bio

Lucia Giudice is Deloitte Consulting LLP’s Government Programs Leader. She assists health plan clients with strategy, product implementations, policy and procedure development, performance improvement, training, regulatory review preparation and compliance program development. Lucia has more than 20 years of experience in health plan operations and government health care programs and compliance, in particular with Medicare Advantage, Medicare Part D and Medicaid plans.