Mountain Pacific Blog

The Centers for Medicare & Medicaid Services (CMS) “triple aim” is to improve health care, improve population health and ultimately lower health care costs through quality improvement. Assessing social determinants of health (SDOH) can be a key factor in addressing both better care and lower costs. While the medical community provides much needed care to patients suffering from illness and disease, the causes of early death are influenced by the factors below. (Note: These statistics are prior to the increase in deaths related to the opioid crisis.)

• Behavioral patterns – 40%
• Genetic – 30%
• Social circumstances – 15%
• Lack of medical care – 10%
• Environmental factors – 5%

The impacts of SDOH are broad. Literature has shown that lower income is related to premature death, and where people are born, work, grow, live and age can complicate access to care and adherence to medical treatment.

While a medical practice is not equipped to address every aspect of SDOH, there are examples within Accountable Care Organizations (ACOs) that demonstrate providing resources or partnering to address these needs can decrease costs.

• Advocate Health Care decreased health care costs by $3,800 per a- risk patient, while decreasing readmission costs by implementing a broad nutritional program.
• University of Illinois Hospital worked with community partners in addressing homelessness and reported a 61 percent decrease in costs for this population, while decreasing emergency department (ED) use by 35 percent.
• MedStar Health and Denver Health Center are partnering with transportation companies to decrease missed appointments.

There will be continued pressure to decrease health care costs in our value-based health care approach. Within the Medicare Quality Payment Program (QPP)’s Merit-based Incentive Payment System (MIPS) there is an increased weight on the cost category to be 15 percent of the total score and, by law, will be increased to 30 percent in 2022. Private payers are also increasing the number of value-based contracts, which, when combined with Medicare and Medicaid efforts, will increase the pressure on providers to control costs.

Up Next: Where to Start on Assessing SDOH