Skip to main content

Linking financial strain to medical and social need

The most immediate point of intersection between hospitals and consumer financial risk is the inability of patients to pay their medical bills. This is changing as the role of hospitals in meeting social determinants of health (SDOH) expands. Low incomes and poor health outcomes are linked across multiple conditions and stages of life.

The short- and long-term risks of financial security are amplified for providers and patients, given just how close so many in the U.S. are to economic shocks they cannot cover or rebound from:

  • A Federal Reserve survey found that 36% of adults could not pay cash to cover a $400 emergency expense; even those who could cover the expense might tap savings or a credit card to meet the immediate need (2020).
  • Race-related outcomes are worse: nearly 40% of employed Black or Hispanic adults in the same survey reported that a $400 emergency expense would make it harder to pay other bills, compared to 18% of employed white adults.
  • This can create a snowball effect, what Health Affairs calls a “crowding out . . . on other important financial obligations such as rent, food, energy and medical debt” (2022).

A person in these circumstances may find themselves not only ill but in need of social services for the first time. Hospitals can help make the connection through data and analytics that link SDOH risk, medical need and community resources.

Finance: Definition, dimensions and risk

As highlighted in a previous blog, finance is one of six SDOH categories that DataGen uses to help hospitals measure social risk: a measure of the non-clinical vulnerabilities that affect individuals and the community. The SDOH categories, including food, housing, transportation, digital competency, and health literacy, can be used discretely or collectively to assess risk, design and deploy interventions, and quantify their impact on the people who need them most.

DataGen’s financial SDOH data is licensed through Socially Determined ­and includes three dimensions: Strength, Resources and Resiliency. Each category contains drivers that help hospitals calculate social risk (none to high) and prioritize need. Individual risk drivers include financial assets and liabilities, while community risk drivers capture macro income and cost of living. Opportunities are drivers at both levels.

To link SDOH investment, resource planning and ROI, hospitals have access to nearly 70 data elements that DataGen uses to identify and calculate risk, scoped into ZIP Code or out to larger disadvantaged areas.

Financial strain, disease and social services

The Milbank Quarterly has highlighted income as key to the “fundamental cause theory of disease” and names social services as one of four ways to address “income-related health inequities.”

Hospitals are under increased pressure to offer market solutions here, but how? One example is a health system that uses social risk data and healthcare analytics to identify its most disadvantaged market. They then partner at no cost with a national non-profit to open multiple counseling centers within that footprint — addressing needs in a targeted, collaborative way.

Through such centers, other SDOH needs are revealed via an analytics-forward approach that is sustainable and long-term. And this is just what patients and providers need: the ability to avoid risk, minimize adverse consequences and improve outcomes across a variety of circumstances.

Labels:

Comments

Post a Comment

Popular posts from this blog

Alternative payment models: Strategies for success

In this edition of DataGen Insights, we look at how alternative payment model participants can ensure their processes and workflows are optimally set up for success. To help, DataGen listed the top three strategies all providers participating in APMs can employ and created a handy checklist to enable maximum returns and reduce financial risk. Please explore our website to learn more about our  products and services .  Download DataGen Insights today .  We hope you enjoy!
Post a Comment
Read more

Why it's critical for Primary Care First participants to control and understand leakage

Patients' primary care visits outside of their attributed primary care office, also called “leaked” patient visits, can have unintended consequences for Primary Care First participants. Beginning July 2022, PCF Cohort 1 will face a reduction in population-based payments based on their leakage rate. The payment adjustment will be based on their 2021 claims data and will roll forward quarterly. To calculate your leakage rate, divide the number of qualifying visits and services your attributed beneficiaries have made to care centers outside of your practice (for example, visits to urgent care centers) by the total number of qualifying visits and services your attributed beneficiaries have made. Calculating primary care leakage with claims data alone comes with some unintended challenges. Unfortunately, some circumstances can unfairly and negatively impact a practice’s leakage rate: Nuances classifying care delivered by provider team members: It’s difficult to distinguish
Post a Comment
Read more

CMMI’s New Enhancing Oncology Model – Deadline Approaching

As the final at-risk period for the Oncology Care Model was closing at the end of June, the Center for Medicare and Medicaid Innovation announced its new Enhancing Oncology Model (EOM). EOM aims to improve the coordination of oncology care, drive practice transformation and reduce Medicare fee-for-service spending through episode-based payment.  What is EOM? EOM is a voluntary, five-year model set to begin July 1, 2023. Patients undergoing chemotherapy for the treatment of cancer will trigger six-month episodes of care.  Eligible EOM participants include physician group practices with at least one Medicare-enrolled physician or a non-physician practitioner who furnishes evaluation and management services to Medicare beneficiaries receiving chemotherapy for cancer treatment.  EOM participants are required to implement eight participant redesign activities to drive care transformation in their practice. Examples include the provision of patient navigation, 24/7 access to an appropriate c
Post a Comment
Read more