Do You Know SDOH? You Should

Health insurers are slowly adopting their plans to include coverage of certain non-medical expenses that have been shown to improve their health. A leading example would be installation of bathroom grab bars to prevent falls, a leading cause of serious injury among older Americans.

Another example is delivering healthy meals for a week or two to people who’ve been released from a hospital after a serious injury or health condition. It’s hard for people to cook for themselves, let alone get out to shop for nutritious food. Being well-fed for two weeks can help speed their recoveries.

Paying for people to take a Uber or Lyft to a medical appointment is another popular example of what is broadly known as coverage of social determinants of health – hence the SDOH of today’s headline.

In the real world, the logic of SDOH is obvious. Spending a little bit of money know can save huge amounts in future medical bills while adding greatly to a person’s quality of life. For all the money we spend on health, medical care is responsible for only about 20 percent of our wellbeing. The other 80 percent is tied to income, housing, food scarcity, and other behaviors.

Reflecting this knowledge in an insurance product is seldom obvious and often very difficult. Not that we’re likely to forget, but private health insurers make a lot of money, so expecting them to suddenly provide a grab bag of new benefits is not going to happen.

What is happening, perhaps too slowly, is that health insurers are looking at their most costly customers. In any given year, more than 20 percent of national health spending is generated by 1 percent of those with insurance. The problem, of course, is that a substantially different 1 percent may generate 20 percent of next year’s spending, and so on.

Figuring out ways to reduce spending by the sickest customers is hardly charity; it can translate into huge savings for insurers, higher profits and happy shareholders. Increasingly, these ways include SDOH. Most programs involve low-income Medicaid and Medicare beneficiaries.

Humana launched an effort earlier this year that reimburses hospitals and other health systems for referring Medicare Advantage customers to food banks and housing assistance programs.

United Healthcare is testing a housing support program, according to a story in the Philadelphia Inquirer. The company’s Medicaid plan, UnitedHealthcare Community Plan of Pennsylvania, screens homeless Medicaid patients with high health spending and tries to find housing for them.

“Many of the people we serve,” the plan’s chief executive Allison Davenport told the newspaper, “experienced such instability that their health care becomes intractable. It compounds, it compounds, it compounds and they can’t address that in a completely unstable situation.”

In a 2019 study, researchers found that more than 52 percent of adults between the ages of 50 and 80 experienced what was described as severe food insecurity – “meaning they sacrificed the quality or amount of food they consumed because they lacked sufficient resources.”

Medicare has stepped up its emphasis on SDOH programs through what it’s calling its Accountable Health Communities Model, which partners with community health organizations to identify people with unmet social needs linked to poor health outcomes.

The numbers of people involved in these efforts is very small and there’s no guarantee they will rise enough to make a dent. Thanks to the pandemic, of course, these unmet needs have become even larger this year.

Starting small, however, is what cautious health insurers do. These early efforts will capture spending data and begin identifying benefits linked with the greatest health improvements.

As with other trends that began with government programs, expect SDOH successes to find their way into employee insurance programs over time. The same insurers who manage Medicaid and Medicare plans also oversee employer plans.

Bit by bit, they will add to a snail-like transition that health insurance knows it needs to make, moving to what is truly health insurance from something that, despite its name, is now just really sickness insurance.