Innovations in Social Determinants of Health

Presenter: Lisa A. Leighton, National Strategic Partnerships, Vice President,
Strategic Community Partnerships, UnitedHealthcare

Lisa will explore the use of data, technology and relationships to address
Social Determinants of Health (SDOH), and expand on current thought
leadership in the SDOH realm. She will articulate what clinicians can do
to help with SDOH challenges.

Transcript

1. Strategic Community Partnerships Lisa Leighton Vice President National Strategic Partnerships
2. Our commitment to Social Determinants Of Health Updated 8/19/19_V1. UnitedHealthcare Strategic Community Partnerships. Proprietary and confidential. Do not use without express written consent .
3. Our Hypothesis – Initiated January 2017 By building an infrastructure around social determinants of health, we can… Redefine health to consider the whole person – not just medical care Remove barriers that limit access to care and address health disparities Improve overall health and well-being of all vulnerable populations Updated 8/19/19_V1. UnitedHealthcare Strategic Community Partnerships. Proprietary and confidential. Do not use without express written consent .
4. Concurrent Happenings: Socioeconomic and Health Care As we pursued our SDoH work, related findings/changes validated the need for SDoH inclusion in health care. 40% of Americans can’t afford a $400 financial emergency1 *2018 1 https://www.federalreserve.gov/publications/files/2017-report-economic-well-being-us-households-201805.pdf 2 Data USA; U.S. Census Bureau, 2017 3 Robert Wood Johnson Foundation, County Health Rankings, “Relationships between Determinant Factors and Health Outcomes” 78% of Americans live paycheck to paycheck1 $60K is the median household income for commercial population2 CMS expands supplemental benefits definition/inclusions* 80% of health is determined by what happens outside of the doctor’s office3
6. 6 Driving Innovation & Transformation Across the Industry ▪ Recognized for incorporating social determinants into clinician workflow to improve care management and enhance health ▪ First payer in Healthcare Innovation (formerly Healthcare Informatics) history to receive this award Updated 8/19/19_V1. UnitedHealthcare Strategic Community Partnerships. Proprietary and confidential. Do not use without express written consent .
7. Physician UnitedHealthcare’s SDoH Infrastructure: How it Works z Data Standardization API Transportation Vendors Social Referral Sources Physician Network Provider Profile Turning disparate data into actionable information to support our members’ social determinants of health. Text Various Data Sources Point of Care Member Navigators Self- reported Data Rx Claims Data Clinical Systems HouseCalls Social Referral Vendors HSA Standard measurement of SDoH data ICD-10 Diagnosis Code Set Categories Counseling Economic Stability Education Employment Health/Health Care Personal Care Respite Care Social /Community Reporting, Analysis and Clinical Outcomes: Identification data Referral data Fulfillment data Social Value to Member – Imputed Market Price (IMPTM) UHC Customer Advocates M&R Advocate C&S Advocate Clinician Clinician Clinical Profile Member Updated 8/19/19_V1. UnitedHealthcare Strategic Community Partnerships. Proprietary and confidential. Do not use without express written consent .
8. 8 Imputed Market Price™ Valuation Tool The Imputed Market Price (IMP) represents the cost a member would have paid if he/she purchased the service out of pocket. Our pioneering, patent-pending tool provides an estimated market value for social services that can be used to ... • Show financial value of social health plan benefits to members • Determine savings of social-service intervention compared to higher-cost health care system utilization • Influence policy discussions on reimbursement models • Show the importance of this work, reimbursement aside Updated 8/19/19_V1. UnitedHealthcare Strategic Community Partnerships. Proprietary and confidential. Do not use without express written consent .
9. What We’ve Accomplished Data source: National Strategic Partnerships (NSP), June 2019. Updated 8/19/19_V1. UnitedHealthcare Strategic Community Partnerships. Proprietary and confidential. Do not use without express written consent . Data from inception (1/1/17) to date # of members who identified at least 1 SDoH # of referrals provided Imputed Market Price valuation (to members) Total membership 1.52M+ 820K $879M+ M&R membership 1.25M+ 706K $789M+ C&S membership 262K+ 114K $90M+
10. Our Network of Vendor Partners Data source: National Strategic Partnerships (NSP), June 2019. Updated 8/19/19_V1. UnitedHealthcare Strategic Community Partnerships. Proprietary and confidential. Do not use without express written consent .
11. April-May 2019: Comment period Nov. 2019: Committee decision, next steps Nov. 2020: If approved, new codes available 11 What’s Changing We proposed 23 new SDoH codes to the ICD-10 governing committee. Supporting Industry Partners: Updated 8/19/19_V1. UnitedHealthcare Strategic Community Partnerships. Proprietary and confidential. Do not use without express written consent . ▪ Support the use of self-reported data. (AHA Coding Clinic will be recommending use to the ICD-10 Committee in August 2019) ▪ Document known social determinants of health (SDoH) ▪ Communicate this change to your organizations and billing staff *”Clinicians” has been loosely defined according to the AHA. 2018 American Hospital Association | April 2018 www.aha.org Coding authorities revised rules to expand coding privileges to all clinicians* involved in patient care. Provider segment encouraged to:
12. 12 Lisa Leighton, VP National Strategic Partnerships lisa_waggoner1@uhc.com What We All Can Do – Together Updated 8/19/19_V1. UnitedHealthcare Strategic Community Partnerships. Proprietary and confidential. Do not use without express written consent .