July 15, up to 14 million Americans May lose their Medicaid coverage if the state’s public health emergency is not extended. Not only will this have devastating effects on Americans who find themselves uninsured, but it will also have a major impact on health care costs, which could drive up costs as providers move to more sophisticated and complex reimbursement models.currently helps The US pays 600% more for healthcare than it should and still produces the worst outcomes of any high-income country.
Our current system is broken. It doesn’t have to be like this.
A huge area of change is addressing how and where we direct our healthcare spending. Currently, according to several studies, 90% of the nation’s health care costs are focused on health care, which directly affects only 10-20% of health outcomes. In fact, 80-90% of a person’s well-being is driven by the social determinants of health (SDOH) they face every day. Where a person works, lives, eats, plays, prays, their job, the school they attend, the air they breathe and the water they drink every day can affect their health almost ten times more than any medical treatment. If we focus on how we address SDOH, especially how we move from a reactive to a proactive approach, there is a great opportunity to make an impact.
For example, in the current reactive paradigm, a person has to show up to the emergency room, receive expensive care, and then when discharged, we try to address some of the non-clinical drivers that affect their health, such as lack of access to food and medicine or lack of access to food and medicine. stable housing situation. But what if we solve the SDOH problem? initiative, identify those at risk before they end up in ED? Through data-guided, active outreach by trained community health navigators and leveraging easy-to-use technology, we can learn ahead of time about the needs of individuals, design and execute care plans, and hopefully keep them out of the hospital .
By shifting the focus to proactive whole-person care, we can ensure the right people get the services and care they need, improving and reducing health care disparities and reducing avoidable health care spending.
Active engagement is key to driving improved outcomes
discovery Learning in 2019 revealed a strong link between SDOH and the development of chronic diseases.as discussed At last year’s MedCity INVEST digital health event, people often have overlapping SDOH, which is the root cause of their medical problems. Current models tend to address and track these issues individually, whether it be housing or lack of food or finances, which in turn lacks validity and misses key aspects of a person’s life experience and situation that are important in removing these factors and Driving improved health outcomes is critical at lower cost.
a 2019 study It was found that food insecurity (SDOH) – which can lead to diabetes, heart disease and other chronic diseases – costs health systems an additional $53 billion annually.
In one community – Nashville, Tennessee – Annual cost of all hospital services 74% of the homeless use nearly $3.5 million in fees (about $1,500 per homeless person). Costs go up when you factor in medical clinics, mobile emergency medical services and the Department of Veterans Affairs.
As a healthcare system, if we start using data to proactively identify at-risk populations, engage early, leverage technology to manage and track their journeys, and rely on trusted community health navigators to provide 1:1 support, we can contribute to the following: Aspects have a significant impact on the overall health outcomes of Americans.
By simply identifying people living or at risk of food insecurity, we can significantly reduce its health consequences, which can be numerous and last a lifetime. Likewise, by proactively addressing housing insecurity and chronic homelessness, we can improve their quality of life, health outcomes, and reduce high costs to local healthcare providers and systems.
Caring needs come from the community
Moving upstream, outreaching and navigating proactively is easier said than done. Who will take this responsibility? With increased responsibilities and staffing challenges, clinical teams have expanded to tipping points. This is especially evident in rural communities across the country. Additionally, community health workers (CHWs) in today’s communities are beyond their capacity – for every CHW served by a CHW, there are hundreds of people who cannot benefit from help. No one serves as a quarterback to guide those seeking help and professionals who are already working in the community to provide service.
That’s why we need to move to a model that combines a data-driven approach with trained professionals to identify those in need who are proactively conducting outreach and care planning for individuals. To be successful, you need people with life experience in the community who can provide guidance, trust, and who can educate and empower people to get the help they need. There are so many great programs and services out there, the nursing community that you can take advantage of. People just need help to get this care before it’s too late.
We need to shift the treatment of SDOH from a reactive approach like treating a broken arm or a heart attack to a more preventive medicine model – early screening helps diagnose and treat cancer, smoking cessation programs reduce lung cancer, regular checkups prevent minor problems from becoming The point – why can’t the same be done with SDOH?
When we wait for issues like food and housing insecurity to show up in our emergency rooms, or rely on our health care system to address and treat them, we miss opportunities to drive substantial change.
Solving SDOH problems effectively cannot be done overnight, but it can be done. It requires building trust between members and their communities, and empowering them to participate in their care and utilize their community services. As our industry, state and local governments grapple with SDOH issues, we believe more proactive and coordinated care from the community is needed to have a lasting impact on many of our neighbors struggling today.
Photo: vaeenma, Getty Images
