Pandemic underscores impact of social determinants of health

Before the pandemic hit three months ago, one of the hottest industry topics was the social determinants of health. Recognition has been growing over the last several years that a huge amount of healthcare costs is driven by people’s lives outside of the doctor’s office. Factors such as food insecurity, isolation, and lack of access to services are just a few of the social elements that contribute to healthcare outcomes. A frail elder without social support is unlikely to manage the intricacies of a complex healthcare system.

The pandemic has drawn even more attention to the link between health and life circumstances. Communities that face social challenges, particularly those of color and the frail elderly, have been hit hard by the disease.

“People’s needs are spiking,” said Michael Monson, senior vice president of Medicaid and complex care at Centene, a St. Louis-based insurer and the nation’s largest Medicaid managed care organization.

While living conditions are widely recognized as a health factor, a big question for seniors housing operators has been how to pay for support services that impact health. Should health systems, or insurers, pay seniors housing operators to track the health habits of their residents and provide interventions?

“We do not have sustainable flows of funds from the healthcare sector to seniors housing,” said Monson.

Piece-meal solutions are slowly emerging. Some Medicare Advantage plans are starting to offer benefits that address the social determinants of health, such as meals and exercise plans. Pilot programs test new approaches but are not widely available.

Because of its impact on vulnerable groups such as seniors, the pandemic could accelerate the push for more social services, experts say. But collaboration will be key to success.

How to link healthcare and housing

In 2019, Centene launched a new subsidiary called Social Health Bridge. Monson is the CEO. Social Health Bridge acts as a financial and interventional layer between the healthcare sector and community organizations, including housing providers. The goal is to improve health outcomes and lower healthcare costs by providing social supports and access to critical services for residents.

Social Health Bridge offers a market-based solution for seniors housing operators, explained Monson. “This is a way to create a regular funding stream to pay for certain services.”

Here’s how it works. Residents sign up to join the Social Health Bridge Network. It includes local health systems, hospitals and physician groups in value-based arrangements that tie compensation to certain performance measures. Residents can have any kind of insurance, whether a Medicare Advantage plan, Medicaid, or a private plan.

The Network pays for a resident service coordinator on-site at the building. The service coordinator links residents to needed services and interventions on behalf of the healthcare providers. Typical services include case management, transportation, and other social supports. A long-term program goal is to place doctors and nurse practitioners on-site with office hours to fill care gaps.

The idea harkens back to the 1960s when HUD-financed senior apartments introduced service coordinators on-site. Centene beefed up that model and introduced standardized protocols, policies, technology systems and oversight. “We give them the tools they need to improve quality health scores while lowering healthcare costs,” said Monson.

Lower healthcare costs result in savings which fund the program. “Seniors housing pays us nothing,” said Monson, adding that many assisted and independent living properties don’t have the budget for an on-site service coordinator. It’s important to note that the seniors housing operators bear no insurance risk, he added, in contrast to programs where the housing operator forms its own Medicare Advantage plan.

The program is suited for independent and assisted living communities, not skilled nursing facilities.

The business model works best with a large risk pool of participants, probably 10,000 individuals or more, said Monson.  To reach that scale, Centene seeks markets where it already has a strong customer base.

Last January, Centene launched its first community partnership in New Orleans with an affordable housing provider. The first step is to assess residents and find them access to care, though Monson said the pandemic has slowed the process. An agreement with a seniors housing community is in the works.

“We are in early days,” said Monson, commenting on the roll-out of Centene’s program. “But this is an option to bring together the seniors housing provider and health system network.”