The Value-Based Care Transition: SDoH, Homecare, and Data Dispersing

With the health care industry trending toward more value-based care models, the role of homecare and access to data becomes crucial. In this interview with Integrated Healthcare Executive, Kim Glenn, senior vice president of government health plans, HHAeXchange, sheds light on how social determinants of health (SDoH) impact homecare and their significance in value-based care.

How do SDoH impact homecare?

SDoH, which include health-related behaviors, socioeconomic factors, and physical environment factors like the conditions in which people are born, grow, live, work, and age have a huge impact on homecare, as they allow caregivers to see the member holistically—instead of only being aware of one aspect of their overall situation and health profile.

Due to the frequency of their visits and personal connections made, caregivers have key insights into their clients’ health and well-being that others within the health care continuum might not. For instance, because they provide care directly in a member's home, caregivers know if individuals are eating, drinking, bathing, etc. They also may be able to identify social and environmental issues, such as mold in the home, an empty refrigerator or kitchen cupboard, or a lack of family, friends, or neighbors with whom the member can connect. This is important because it better enables the provider to effectively address such SDoH factors to better improve outcomes and lower health care costs through the prevention of worsening chronic conditions and the need for emergency care or lengthy hospital stays.

Can you explain the role of home care providers as the health care industry transitions to value-based care?

Homecare providers are central to the value-based care model. Rather than reimbursing providers based on the quantity of services delivered, value-based care pays providers based on the quality, rather than the quantity, of care they give patients.

While clinical factors, such as medical care and the nature and consistency of that care, make up 10%-20% of the modifiable contributors to health outcomes in a population, SDoH takes up the remaining 80%-90%. Given that homecare providers and caregivers have key insights to a member’s SDoH factors, they play a vital role in also ensuring SDoH are being considered in the full equation. Emphasizing SDoH in the transition to value-based care can prevent declines in member health or habitual hospital readmissions.

Can you discuss the importance of collecting and dispersing data to the care network and how that affects the providers, payers, and patients?

As the industry shifts to a value-based care model, access to this data is more critical than ever—and homecare is uniquely positioned to collect the data needed to reduce adverse and costly events for members.

Providers can train their caregivers to observe, note, and report changes in condition and other potential health risks back to the health plan’s care management team. This data can then be made actionable before a condition worsens or a social determinant—or other risk factor—starts to have a negative impact on overall health. Technology can also aid in streamlining member observations, reporting procedures, and collecting data that can be utilized to develop effective population strategies for the future.

With the right data and tools, caregivers, providers, and payers can work together to collect this information in the home, initiate the proper care services, and drive better outcomes.

Is there anything else you would like to add to the conversation today?

I’d like to highlight how much COVID-19 brought light to the significance of SDoH on population health. Because of this, the Centers for Medicare & Medicaid Services and state Medicaid programs are working to improve investment efforts into the innovations and solution initiatives surrounding SDoH. For example, it is now realized that Medicaid managed care organizations may be better equipped to address members’ SDoH and health equity compared to fee-for-service models, most notably when pertaining to population health management strategy, health equities, care coordination, and value-based payment.

Being able to utilize clinical data and SDoH observations, and having tools such as comprehensive provider and payer platforms that give providers and payers insights into the factors that correlate with specific conditions or adverse health events is extremely important. With a full view of all aspects impacting members’ health, providers and payers can proactively address issues to reduce adverse and costly events and ensure members have the chance to lead better lives.

About Ms Glenn

Kim Glenn is the senior vice president of government health plans at HHAeXchange, where she leads the company’s business development, growth, and government relations strategy within the Medicaid Managed Care and Medicaid Fee-For-Service markets. She has been consulting to and serving Medicaid programs with technology solutions for over 30 years.