Care Management

During this time when the whole world is wrestling with the Covid-19 crisis, planning for the future is difficult. However, there is no question that as the nation emerges from its stay-at-home status, there will be huge release of pent-up demand – especially for healthcare. Health systems have streamlined their operations to deal with the influx of COVID-19 testing and treatments. As a result, any non-emergent care or care unrelated to COVID-19 has been heavily gated, if not canceled entirely. This of course includes preventative care, non-critical regular screenings, and other services related to care gaps. Once the patient flow moves out of crisis mode, these services will certainly resume – and they will resume in earnest. This increased demand for services, coupled with the time lost to meet quality metrics, will place a real burden on member services and quality teams as they work to ensure missed preventative care, screenings, and other care related to care gaps are being sought and coordinated. It is possible to make small moves now to strategically prepare for what’s coming, so that when the crisis subsides organizations can be well positioned to serve their members. Here are a few key things payers can do to get ready: Get your data and strategy in order - Now is the time to use data to better understand your members and fill in any gaps you may have. For example, it is going to be essential to understand geographies and associated provider groups where care gap non-compliance is likely to be highest, so you can strategically focus on those areas. Also, understanding what the best channel of communication is and ensuring that you have accurate contact info for those members is critical. Fundamentally, plans will need data that can help them identify who to target and can supply needed, accurate contact info.Understand your members' SDOH barriers – Understanding your members' social determinants of health (SDOH) barriers will be more important than ever. One of the unfortunate byproducts of this COVID-19 crisis is the economic damage. As a result, there will undoubtedly be critical gaps, like transportation, that will affect your members' ability to access care and thus need to be accounted for. Likewise, with the downturn in the economy, additional social determinants will be on the rise, like food insecurity, housing insecurity, and access to medications. These should also factor into your overall plan – and thankfully there are increasing ways to identify and track SDOH.Implement digital tools now – Ensure your member engagement strategy is fully informed and your teams are ready to efficiently execute. While data can round out any information gaps that may exist for you – contact info, SDOH gaps, etc. – tools that can provide quick, convenient access to services will be needed to take action. For example, enabling your member engagement team with a digital scheduling platform that allows them to book appointments with providers without calling the provider, is a proven way to accelerate member engagement and close gaps in care. This type of digital engagement not only provides an efficiency gain, it also greatly improves the member experience as call times are shorter and members are given greater access to care. In times like this current pandemic it can be hard to think about much else beyond the here and now, and especially hard to picture a brighter future. But prudence would dictate that taking a little time now to prepare can make a big difference when things do start to open back up. Find out more about data driven solutions for member engagement.

As COVID-19 cases climb in the U.S., healthcare providers are strategizing on ways to prioritize testing for specific patient populations and determine overall treatment plans. Already, the world has identified that people age 65 and older, and those with underlying medical conditions, are more susceptible to severe symptoms from the coronavirus. Another group who could be at greater risk? Those individuals with barriers to health, like social determinants. Social determinants of health (SDOH) are the non-medical factors of healthcare that account for up to 80 percent of health outcomes. When patients struggle with access to care or access to medication, they’re less likely to follow treatment plans or show up to important follow-up visits. In the case of the coronavirus, some providers are now considering SDOH to flag particular data fields in an attempt to identify patients with access to care challenges, specifically where a remote health service or telehealth option would be especially helpful. Drive-thru coronavirus testing sites are popping up across the country, and healthcare facilities in all states are encouraging individuals to leverage telehealth solutions instead of flooding sites with in-person visits. SDOH screening could assist in proactively identifying individuals who need to be routed to different care channels. Consider the following: Patients screened for testing may live outside of driving distance to a hospital or clinic. Should these individuals be guided to a different testing option or alternative location? Some people screened for a test might live alone, without a vehicle, and are unable or unwilling to walk to a testing location. Those with symptoms are discouraged from using public transit, so is at-home testing a better option?Additionally, those who live alone without a vehicle may need a proactive check-in to ensure they have no untested symptoms. Could that help prevent a 911 call and additional stress on the emergency department? Proactively screening a patient population by  “access to care” data could enable a provider to  expand its coronavirus care strategy and consider information that might mitigate future surges in coronavirus cases and ED and clinic visits. Giving attention to patients or members with non-clinical needs and pairing them with the right engagement strategy before they require an escalated response can have a positive impact on clinical services. “Integrating SDOH data into clinical systems is something providers are just beginning to do, but the response required by COVID-19 presents an opportunity to accelerate that,” said Karly Rowe, Vice President of Product Development for Experian Health. “Identifying at-risk patients who may need help tapping into personalized screening and treatment options could help providers quickly suggest the ideal course of action for individuals, and at the same time conserve resources and contribute to the safety of staff and the larger community.” It’s early days of COVID-19, but data will certainly be a differentiator in managing the first pandemic in the 21st century. “Speed, efficiency and accuracy are critical in situations like what healthcare professionals are facing today,” said Rowe. “Innovative use of data is a big part of delivering on those.”

COVID-19 is beginning to stress the healthcare system, and typical protocols are being upended. But health systems and medical groups are already rising to the challenge of getting patients tested while, at the same time, prioritizing the protection of their communities and staffs. Below are some solutions being implemented: Online screening Many providers are tapping into online scheduling solutions, responding to the COVID-19 crisis with simple splash pages. Posting questions that screen for symptoms can channel patients seeking testing/treatment for COVID-19 down a specific pathway to get the care they need. Those who need other types of care can still book through the solution, directing them to the right provider and appointment. Screening paths allow access to be prioritized and managed accordingly. Mobile testing Providers are also using mobile test units. These enable providers to administer more tests in a geographically diverse manner, without having to expose their internal clinic and hospital environments to contagion. Patients can simply drive through and receive a test while remaining in their car. Some health systems are combining this with online scheduling, allowing patients to schedule appointment slots for testing. This helps manage the flow of patients, reducing call center volume. Health plans are also modifying Some health plans are taking a similar approach, using mobile testing units and a call center scheduling platform to book testing appointment slots for members. Likewise, they can send a link enabling members to self-schedule for a testing slot via text message or email. This type of proactive member engagement to vulnerable populations is key to reducing the impact on Emergency Departments, while helping diagnose individuals so they can get the care they need. Call center operations Call centers are being overwhelmed with volume – and there is more to come. New methodologies to handle the response are complementing normal operations. Some providers have started to publish a dedicated line for COVID-19 calls that connects to a separate call center pod. Others have quickly added scheduling protocols in the scheduling system to route patients to the right care, or mobile-testing unit, based on responses to the questions agents ask. By automating the Q&A in the platform, patients are guided to the right care, and agents need minimal training to assure accuracy. As the number of COVID-19 cases continues to grow in the U.S., more tactics will be introduced to streamline scheduling, testing and care. Technology will certainly be one key lever for healthcare providers to better serve their communities and keep patients and staff safe.

The stats are alarming: Up to 80% of health outcomes are not due to medical factors, but to a patient’s social and economic circumstances—such as their income, housing situation and even whether they own a car.68% of Americans are affected by at least one social determinant of health (SDOH).Approximately 24% of hospitals and 16% of physician practices screen for food insecurity, housing instability, utility needs, transportation needs, and interpersonal violence—which means the majority don’t screen for all relevant social needs. The healthcare industry has been talking about the importance of addressing social determinants of health for years, but many struggle with how to collect the insights. For example, if 68% of Americans are affected by at least one SDOH, how do they even discover the one? What is the ideal way for providers to screen for SDOH? Should they simply ask the patient? Do they start a visit with a survey, probing for details that could ultimately impact care management decisions? Providers know these sensitive topics – housing instability, financial instability, food insecurity and onward – can be tough and uncomfortable conversations. So, where to begin? Should you rely on patient surveys to capture SDOH? Patient surveys can be a useful way to find out about many potential barriers to care. However, they bring limitations: Your insights will be limited to the patients who show up—so anyone who has struggled to attend an appointment (and therefore potentially with higher needs) will be left out It can be time-consuming and expensive to give staff the time and space to conduct personal interviewsThey rely on patients to be willing to share openly, but some may not feel comfortable doing soThere is room for error in how questions and answers are interpreted by both the survey team and respondentsSocial circumstances can change over time, so it’s possible that the information gleaned in the survey may not be relevant a few months down the line. Knowing SDOH can have such a huge impact on a patient’s health certainly means clinicians should discuss these topics in the exam room, but relying solely on patient surveys and conversations could lead to gaps in intel. When should you screen for SDOH? Screening for social needs when a patient first registers or engages with your services is a good starting point. But what happens when their situation changes between diagnosis and treatment? What if they disclose a social need to a specialist that wasn’t flagged on their initial intake form? Does your staff know how to discuss sensitive social issues? Can they create a safe space for patients to share? Have you got clear referral pathways when an issue is flagged? Look for possible touchpoints in the patient’s journey where referrals to support services would be appropriate. Looping in the relevant primary care services is a good way to make sure your patients are connected to community-based programs and supported throughout their journey, whenever a new or changed social need is identified. What types of data could offer the SDOH insights a provider needs? Geographical and community-level data can help a healthcare organization understand their patient population’s income, housing situation and employment status. These are useful for population-level care planning but aren’t patient-specific. A better way is to analyze securely collected consumer marketing data for more specific and accurate information. Working with a trusted data vendor that is a compiler of original-source consumer data can help you navigate your options. The real predictive power of SDOH data comes when you combine patient-specific information obtained through screening, with consumer databases. A third-party vendor can help you access data on your patient population’s income, occupations, length of residence and other social and economic circumstances. Your care managers can use this to inform proactive, preventative conversations with patients to solve any non-clinical gaps in care. Bottom line … When healthcare organizations have a holistic view of patients—and the SDOH that play a role in their lives—they can take steps to help prevent avoidable hospital visits, emergency department (ED) utilization, appointment no-shows and worsened conditions by encouraging and facilitating earlier interventions. The key is to start with the right data.

Did you ever have someone tell you, “there’s no magic pill” for reaching a goal? It’s a somewhat ironic analogy, given that so many people struggle to take their meds as prescribed. Following a medicine schedule actually takes a lot of organization and discipline, never mind the financial and emotional cost of having a daily reminder that you’re not well. It’s estimated that 50% of patients don’t take medications as prescribed. Sometimes a patient is busy and misses a dose. Maybe they forget whether they’ve taken it already and accidentally take double. Perhaps they feel better and decide to stop a course of meds early. Or maybe they can’t get to the pharmacist to get their refill on time. Unfortunately, medication non-adherence (MNA) can have a more direct impact on a patient’s condition than the specific treatment itself, according to the World Health Organization. Non-adherence is thought to contribute to nearly 125,000 deaths and 10% of hospitalizations each year. It costs the health care system between $100–$289 billion each year, and according to a study by Walgreens, for every 1% improvement in adherence, $50 can be saved in healthcare spending. The causes are varied. Of course, patients have a role. But healthcare organizations operating at various points along the care continuum can also play a big part in helping or hindering patients in sticking to their prescriptions. Doing so is in everyone’s interest, as tackling non-adherence can help reduce readmissions and avoid more serious medical conditions, improve patient loyalty, yield financial savings and create a better experience all around. Here are three ways different healthcare organizations can help patients stay on track with their meds: 1. Keeping accurate patient records from hospital to home When a patient is hospitalized, it’s fairly easy for them to stick to a medicine schedule. Drugs are dispensed in the same building and brought right to the patient’s bed at the appropriate time. The problems arise when the patient goes home. They may leave hospital with new prescriptions which can be confusing and if they already have a prescription, the admission itself can disrupt their usual routine. As things stand, hospitals tend not to be reimbursed for interventions to improve adherence, so these are less likely to be prioritized during care transitions. But given the likely improvements to patient outcomes and consumer loyalty, and the fact that hospitals could save $37 for every dollar spent tackling MNA, these interventions are worth a second look. A simple but effective place for hospitals to start is in improving patient identities. When your clinical teams know they have a 100% accurate and up-to-date record for each patient, including their current prescriptions, they can help the patient stay on track and prescribe new medicines with confidence. New identity management platforms such as Universal Identity Manager can help you keep track of patients and their meds, reducing the risk of medical errors and avoiding billing mistakes associated with duplicate prescriptions and preventable readmissions. This ‘golden thread’ of patient information can also improve communications within and between providers in your health system, such as Accountable Care Organizations (ACOs), pharmacies and other community providers. 2. Understanding and addressing wider barriers to adherence Common barriers to adherence often relate to a patient’s circumstances at home, such as not being able to get to the pharmacy because of a lack of transport, or because the opening hours don’t fit with their work schedule. For patients juggling work, childcare and other responsibilities, refilling their prescription can easily slip down the to-do list. Pharmacies can help by offering logistical support such as automatic refill programs, home delivery and help with organizing medication into pill boxes. But how do you know which intervention will be most relevant? This requires a wider understanding of the make-up of your patient population and their needs, preferences and behaviors. Understanding the social determinants of health can help you identify the specific barriers to care for your healthcare consumers, so you can put in place the right response. 3. Develop patient engagement strategies to help patients take their meds It’s not just those directly involved in providing care who can help improve MNA. Payers can help in two major ways: firstly, by supporting members to overcome barriers such as cost and confusion, and secondly, by working with hospitals and pharmacies to help them develop effective strategies to reduce non-adherence. For example, Blue Cross Blue Shield of Arizona (BCBSAZ) has introduced a text messaging service to send reminders to members about their prescriptions, with a $45-50 discount on copays for those that refill on time. It’s hoped this program will tackle behavioral barriers to adherence such as procrastination or forgetfulness, while also addressing price concerns. Chris Hogan, Chief Pharmacy Officer at BCBSAZ described the program “as being a very high tech, modern, simple and effective addition to our overall initiative to improve medication compliance.” This kind of personalized patient engagement can be very effective in helping patients to stay on track. With ConsumerView, you can access a wide range of high-quality demographic, psychographic and behavioral consumer data, to help you offer personalized support such as digital reminders to your patients. You can develop engagement strategies tailored to the specific needs of your patients in just a couple of clicks. Could one of these strategies help your organization do more to improve medication management? Learn more about how we can help you help your patients – and your bottom line.

  I attended the Fall 2019 Conference of the National Association of Accountable Care Organizations (NAACOS) in Washington D.C. and wanted to share some insights on how top-performing Accountable Care Organizations (ACOs) are using data to drive improved quality and cost of care. Over the last decade, we’ve seen the number of ACOs surge. Propelled by the shift from volume- to value-based care, over a thousand ACOs operate across the U.S., bringing together groups of physicians, hospitals and other providers with a collective ambition to enhance quality of care, reduce healthcare costs and improve patient outcomes. While some ACOs participating in the Medicare Shared Savings Program have succeeded in improving quality and realizing some savings for the program, the value-based model is still evolving, and results can be mixed. More dramatic and holistic moves will have to be made to convert today’s annual incremental savings of 1 to 2% to make a dent in the estimated annual waste of nearly $389 billion in administrative complexity and another $45 billion due to lack of coordinated care. So what separates the top performers from the rest? At NAACOS last week, speakers confirmed that the most successful ACOs are those that effectively shift care towards primary care physicians (PCPs) and away from acute settings and skilled nursing facilities, implement a process for continuous improvement and adopt a performance-first culture. This is easier said than done. Here’s my top recommendations to help ACOs leverage data-driven insights to lower costs while improving patient outcomes. Offering insights into member utilization of healthcare resources in real-time I recently worked with a client that needed real-time alerts of member activity including admissions, discharges, and Emergency Room (ER) visits. These insights enabled this client to proactively manage active member episodes of care, optimizing the setting and deliver of care for the member’s specific needs. For example, a member was frequently visiting the ER with complications from his Chronic Obstructive Pulmonary Disease (COPD) condition that the client’s care team was managing. This was a needlessly costly way to treat the symptoms. To help get their members the right care at the right time, this client started leveraging automated alerts for their members as they presented within the healthcare continuum. The next time this patient sought treatment in an out-of-network ER for their COPD, their primary care physician (PCP) received an alert about her patient as soon as they registered, before a doctor had even seen him, and certainly before an ER workup converted to an admission. The PCP called the attending ER doctor to share the patient’s history and ensured the ER physician that this patient would receive next-day follow-up care in the PCP’s office. Knowing that follow-up was in place and the patient wasn’t in immediate need of care, the ER physician discharged the patient home. Given that the average cost of an admission can run $22,000, and an outpatient visit less than $500, the savings delivered by this kind of care coordination becomes significant. More importantly, the member experience is much improved in that they get to go home instead of an unnecessary overnight stay in the hospital. And this is just one example—multiply this kind of episode management across all member encounters and consider the improved member quality of life across all attributed lives and the savings for the health plan or ACO in the aggregate. Real-time alerts provide a win-win for both patient and ACO by affording care teams the opportunity to optimize the setting of care for quality and cost. Care coordination for episode management To improve episode outcomes and reduce readmissions, visibility into the compliance of a patient’s post-discharge care plan through the duration of the entire episode is critical, so well-coordinated care requires that clinical context be shared between providers. A frequent barrier to this flow of useful data is that clinicians’ electronic health records (EHRs) aren’t always interoperable. To solve for this, some ACOs are attempting to move all their providers to a single EHR and care management module. However, for some this may not be an option. In these cases, ACOs can opt for Care Coordination Manager: a rules-driven, closed-loop messaging and distributed workflow orchestration platform that enables health plans, ACOs, allied health, and community partners to share and assign care plan requests across a diverse provider community. Care Coordination Manager is vendor-agnostic and able to populate EHRs and care management modules at the point of care with key clinical context. This flow of tasks and content supports high-quality coordination of care and management through transitions of care. Proactively address non-clinical barriers to health for improved patient engagement and health Another characteristic of top-performing ACOs is that they utilize a 360-degree view of their members to address potential barriers that prevent members from engaging in their own healthcare. These SDOH factors can include things like housing or financial instability, food insecurity, limited access to transportation or healthy food options, and other non-clinical factors. Only about 20% of costly health episodes are due to medical factors, so it’s vital for ACOs to incorporate a more comprehensive and actionable understanding of the social needs of the populations they serve. For example, medication adherence is a bigger challenge for a patient who may have difficulty getting to a pharmacy or understanding medication instructions. Identifying and mitigating these risks up front gives the patient a better chance of adhering to their prescribed regimen, which in turn gives them a better chance to stay healthy, ultimately lessening the disease burden and thus the cost of the ACO’s membership while improving the patient’s quality of life. ACOs can take a proactive, preventative approach to addressing these challenges by collecting and analyzing member data and using these insights to tailor interventions. Patient-supplied information through surveys, like PRAPARE, is a good starting point, but surveys can be limited by access to the patient as well as the patient’s ability or willingness to answer honestly. Additionally, unless mapped to structured data such as ICD-10 Z codes, survey data is challenging to scale for broader insights into the ACO’s membership. Instead, consider healthcare consumer data that’s sourced directly from a reliable vendor. Analysis of this demographic, psychographic and behavioral data allows you to flag patients based on need, so you can identify the best way to communicate with members to help them own their healthcare journey. For example, in a recent report by the Department of Health and Human Services’ (DHS) Office of Inspector General (OIG), one ACO described how asking patients with chronic conditions to make a daily call to a care coordinator led to 43% fewer emergency room visits and 47% fewer readmissions. As ACOs grow amidst pressures to take on downside risk and manage costs while improving quality—timely data collection, sharing, analysis and action will continue to provide the foundation of high-quality episode and population health management; along with engaging members and community partners in the healthcare journey. What’s clear from discussions at the NAACOS conference last week is that the opportunity exists to work smarter across many emerging payment models. Could data be the key to unlocking that opportunity? McLain Causey is Director of Product Management at Experian Health.

Last week, I spoke at the technology briefing of a national health plan group to give a presentation on the role of consumer data and patient identity in healthcare and how social determinants of health (SDOH) can help payers improve population health and lower costs. To illustrate the importance of leveraging consumer data for SDOH outcomes, I like to use the example of Vern. Vern is 78 years old, lives alone in a lower income apartment complex and hasn’t attended a wellness check in several years. Last month, he had an unexpected trip to the emergency room (ER) due to heart disease and continues to be readmitted for his condition. But why does he keep getting readmitted? Is it because he can’t afford his prescribed medication? Is he having a difficult time finding transportation? Or could it be that when it comes to healthy eating—buying fresh product on a weekly basis is challenging for him? These are some of the SDOH that could be contributing to Vern’s readmission—not solely his now heart disease. Had his care team known more about Vern, aside from his condition, they could have proactively addressed some of his barriers to care and prevented the ER admissions—saving them from costly care episodes and preventing negative outcomes for Vern. By utilizing SDOH insights, Vern’s care team can help ‘even the playing field’ for him by understanding his non-clinical barriers to health, what key things are driving those barriers, and what makes sense to address them.  All of this, of course, underpinned by an accurate identity (but, let’s talk universal patient identification another day!). With SDOH insights, Vern’s care team could have gotten him to his wellness checks, his condition would have been detected earlier and he would have received the services he needs proactively. This would save countless dollars in repeated readmissions, ER visits and other costs associated with a chronic condition that can’t get better when your members don’t have the luxury of prioritizing health over basic needs. To avoid these missed opportunities, many healthcare organizations are turning to consumer data to understand their patients or members better. Insights on SDOH are transforming the care experience for people like Vern, as well as saving money for patients and the healthcare industry. Here are three ways consumer data is driving improvements in population health and lowering healthcare care costs at the same time: Helping patients lead healthier lives Research shows that clinical care alone is not enough to safeguard a person’s health. Up to 80% of health outcomes are attributable to non-medical factors such as your financial situation, stability of living arrangements, access to transportation and healthful food options, amongst other things. Around 68% of Americans are affected by at least one of these SDOH, which can make prioritizing good health a challenge. When healthcare organizations are more informed of the SDOH impacting their patients or members, they can take steps to help prevent avoidable hospital visits, ED utilization, appointment no-shows and worsened conditions by encouraging and facilitating earlier intervention. For example, 1 in 8 Americans are food insecure.  If care teams are able to recognize when this is an issue for the people they’re caring for—they can look at partnering with community organizations, like a local food bank or meal delivery service, to address gaps in nutrition for better health outcomes. Reducing the financial burden of healthcare expenses In the U.S., healthcare has the world’s largest gross domestic product (GDP) spending (18%).  By helping your members overcome barriers to attending appointments and potentially discovering health issues sooner, the healthcare industry can reduce the costs of healthcare. For example, 3.6 million Americans miss out on medical care due to transportation problems. If care teams knew who they were and what specifically is impacting them ahead of time, they could step in to arrange transportation or offer alternative options, like telemedicine, so problems can be detected earlier. Not only is this better for the patient’s health, it’s better financially too—emergency room visits cost an average of nearly $2,000 while inpatient hospital stays come in at an average of $10,000. When 33% of ER visits are from those experiencing homelessness—the extreme condition of housing instability—it’s imperative that we consider more than a patient’s profile from a claims or clinical data perspective. Offering a better patient experience When healthcare organizations can see each patient as a whole person, they can offer better engagement plans that make prioritizing their health a smaller mountain to climb. Does your patient prefer information by phone, text or email? Do they use their patient portal? Are there other services they might benefit from, that can help improve their health in other ways? Armed with the right data, you can answer these questions and tailor your communications with each patient, ultimately helping them achieve better outcomes. What’s more, when you leverage consumer insights to improve your population health strategies, you’ll also create a better patient experience through improved care coordination, prompt referrals and timely information sharing—making the whole process better for everyone. Translating consumer data into intelligent business decisions With reliable consumer data sourced from Experian—an original-source provider and data steward when it comes to consumer privacy—you can learn more about your patients and make the right care management decisions to address the non-clinical barriers to health impacting the health of your members and your organization. Learn more about how to leverage consumer data to help improve outcomes for your patient population. Mindy Pankoke is a Senior Product Manager for Experian Health

Most healthcare consumers spend only a tiny fraction of their lives in the clinical world of medical appointments and procedures. Where and how they spend the rest of their time has a far bigger impact on their health and well-being. So why are some providers still relying primarily on clinical data to devise their care plans? Clinical data is crucial when it comes to a patient’s diagnosis and treatment options, but it tells you nothing about their ability to stick to a care plan when they get home. How do their living situation and lifestyle habits play into the physician’s treatment recommendations? Consumer data is the missing piece of the healthcare jigsaw. When providers have insights into their patients’ social and economic circumstances, they’re better placed to spot the factors that might hinder access to care, and offer a more holistic, tailored and effective support plan. The predictive power of consumer data Let’s imagine a single mom of two small kids, working two jobs. Her daily life is a race to get everything done on time, give her children what they need and still make ends meet within her weekly budget. When a reminder for her annual wellness appointment flashes up on her phone, she adds it to her mental to-do list. But by the time the appointment comes around, the stress of taking time off work and scraping together the cash for gas or bus fare means she puts it off. She doesn’t go. Six months later, she ends up in the emergency room with symptoms of a serious illness. Had her provider known about the barriers in advance, they could have supported her to get to her appointment and discover her illness sooner. As Dr. David Berg, co-founder of Redirect Health says, “the most important part of getting good results is not the knowledge of the doctors, not the treatment, not the drug. It’s the logistics, the social support, the ability to arrange babysitting.” Consumer data, such as car ownership, employment status, income level and family information can give you these insights early enough to take action. You’ll know whether your patients can get to their appointments easily, whether they can afford childcare, and a whole host of other factors that might affect their ability to stick to a care plan. And once you know those things, you can offer tailored support to give them the best chance of success. How to gather non-clinical insights According to PwC, around 78% of providers lack the data to identify patients’ social needs. Many have basic demographic information on their patient populations, but are missing the more sophisticated insights that could help them better support patients. It doesn’t have to be complicated, but there are a few considerations healthcare providers should vet as they gather and use consumer data to help drive care plan compliance: Evaluate the pros and cons of patient surveys The obvious way to find out more about your patients’ needs is to ask them directly. A survey at the point of registration can help you understand what barriers may prevent them from attending appointments, taking prescriptions or following other medical advice. However, surveys can be time-consuming and expensive to administer, and recording answers by hand can lead to errors. How a patient interprets the questions and how your team interprets the answers may affect the usefulness of the survey data. And a patient’s circumstances may change between completing the survey and trying to follow the care plan. This approach also only includes patients who manage to attend an appointment in the first place. Those without access to care such as the mom in the example above, would be omitted from the survey, so you would miss out on discovering how to help them. Tap data vendors to deepen your consumer insights A third-party data vendor can give you access to data on your patient population’s income, occupations, length of residence and other social and economic circumstances. When this data is packaged up for your care managers, it can be used to inform proactive, preventative conversations with your patients, to solve any non-clinical gaps in care. It’s more cost-effective than patient surveys and removes the risk of personal bias and interpretation. Ensuring the reliability and integrity of your data vendor can be a challenge. Data brokers often use consumer data collected in retail and other industries, which may not be completely relevant to your activities or collected in a way that meets the requirements for use in healthcare settings. It’s crucial to be able to verify the source of the data and confirm that individuals were told how their data would be used and given the choice to opt out. Always ask your vendor if they are an “original source compiler." Working with a data vendor in the health space, such as Experian Health, can help avoid these pitfalls, as they will have expertise in the appropriate use of consumer data in healthcare. Understand permissible use of consumer data to stay compliant To use consumer data successfully, you must have confidence in both its accuracy and your ability to safeguard patient privacy. For example, are your data collection processes compliant with the General Data Protection Regulation (GDPR) and the California Consumer Privacy Act 2018 (CCPA)? Working with a data management partner who collects data directly from consumers means you can verify that all privacy requirements and opt-outs are in place. They’ll also help you scrutinize hundreds of public and proprietary data sources, so you use only the most relevant, up-to-date data to inform your decision-making. By evaluating and understanding these three areas, you’ll be able to leverage consumer data to tailor your patient engagement and support and make it easier for your patients to comply with their care plan. The more you are able to see and treat each patient as a whole, individual person, the better their health outcomes are likely to be. Consumer data lets you do that.

When nearly 80% of health outcomes can be traced to non-medical social and economic factors, we need to look beyond the medical world to improve them. Perhaps a lack of transportation prevents a patient from attending an appointment, or juggling two jobs makes it difficult to collect a prescription. Maybe a patient’s care plan calls for lifestyle changes that are simply unrealistic in their current circumstances. When life gets in the way, there’s only so much the physician can do. Creating and maintaining a healthy, happy population truly takes a village – from your clinical team to the community resources around your organization. For many healthcare providers, there’s probably a lot more going in their ‘village’ than they realize. Do you know who your patients really are, beyond their lab tests? Do you know what nearby services are at your disposal to help you offer the best possible care? Knowing your patients and your health improvement ‘village’ means you can offer a personalized experience to your patients, to improve their care management and ultimately help them achieve better health outcomes. 3 ways to tailor care management for better patient outcomes Let’s imagine two patients, who have both recently broken their wrists and been treated in your facility. Gene is 71 years old and David is 34. From the clinical perspective, it might be reasonable to assume that David, being younger, should simply receive discharge directions and a time for a follow-up appointment, and be on his way. Gene, being older, might require a series of follow-ups. But thinking of the village analogy, is there more you could learn about Gene and David to engage with them in a way that’s tailored to their specific needs? Here are three ways social determinants of health data can help you do just that. Use non-clinical data to get to know your patients Non-clinical data can help you learn more about your patients and the lifestyle factors that might affect their health. This allows you to address issues like excessive healthcare utilization, preventable readmissions, no-shows and low patient engagement. Surveys at the point of registration are one way to get fresh socio-economic insights. But these can be cumbersome to implement, and findings can be limited by the nature of the questions. You might also review geographical and community-level data to discover your local population’s income, housing situation, employment status, and so on. This can be useful for population-level care planning, but it’s not patient-specific. A better way is to analyze securely collected marketing data for more specific and accurate information. This could tell you that Gene’s living situation actually has a minimal impact on his ability to access care, healthy food and reliable housing. Additional follow up appointments may still be appropriate, but perhaps less urgent. By contrast, you might find that David has limited access to care because he lives alone and far from public transportation. His lifestyle suggests he’d be unlikely to prioritize getting gas to drive to a follow-up appointment over getting to work. In this situation, a remote health appointment might be the better plan. Know your community resources Once you know what David and Gene might need, you can point them towards any appropriate community resources to increase their chances of a quick recovery. Of course, to do this, you need to know what and where these resources are. For example, can you link David to an appropriate home health or telehealth program, or is there a non-emergency medical transportation service in your area to get him to his appointments on time? If Gene needed support to follow a healthier diet, would a local food bank be available? If either had an unstable living situation, would you know which local or national housing coalitions could help put healthcare within reach? Tools such as NowPow, Aunt Bertha and Healthify exist to connect the dots between patients, providers and wider community resources, and close the gap in holistic care. Be proactive and preventative by holding conversations with your care teams prior to seeing patients When you have reliable insights and data analytics to anticipate what patients like David and Gene might need, you can work with your care teams to develop a shortlist of options ahead of time. In this way, they’ll have realistic and ready-to-use solutions to give the patient right there and then. To truly get the most out of social determinant of health data, your care coordinators need easily digestible patient profiles which they can understand and use in a split-second. Bringing the whole patient into the care plan Healthcare is growing more and more sophisticated in identifying ways to better manage care for patients by using data science and machine learning to predict health events. These insights help coordinate care plans that are preventative and proactive. Essentially, it’s about knowing your patients as well as possible, and being able to quickly match them to the services they need. ⁠— Discover how we can help you leverage social determinants of health data for your patient population, so you can bring in the whole ‘village’ of resources to support them on their healthcare journey.