How Social Determinants Of Health Will Help Insurance Brokers In 2021 And Beyond

Social determinants of health are rapidly becoming more important to employers looking to provide new benefits and more attractive policies for their employees and remain cost-sensitive to the corporate bottom line.

In addition, any large employer considering taking on risk (through being self-insured or through value-based care relationships with local health entities) must understand the complexity of the socioclinical drivers on the health-care costs of their workforce and their families.

SDOH account for 70%-80% of the factors that affect population health. Health care costs then follow these factors. These factors are social, behavioral and environmental elements, including access to quality housing, food, education, transportation and income. All of these have a direct impact on employee health and well-being.

Forward-thinking brokers know that analyzing these factors as renewals approach will lead to informed decision making about the best fit health care plans and total benefits packages. When employers keep their workers healthier and more productive, their corporate bottom lines become more robust.

Quite simply, when employers choose plans that address social risk through the SDOH, it materially affects their business revenue by reducing employee absenteeism and increasing the quality of employee care provided through the plan benefits. This is a win for all involved.

In this chaotic COVID-19 era, employers are not well positioned to manage and support their employees’ social determinant needs. Employers must leverage and expand the use of SDOH insights and targeted support programs across the corporate benefit sector. The employer’s success largely depends on their ability to anticipate and manage socio-clinical health care costs as they still maintain cost-acceptable premiums.

Under pressure to find better ways to control health care costs as premiums continue to rise, SDOH insights and quantification of impact give employers the power to do this while playing a more meaningful role directly in communities that are experiencing unprecedented social and economic instability. Furthermore, awareness of the strategic importance of SDOH allows employers to invest in programs that bring value for employee subpopulations by role and reduce costs of care and pharmacy spending.

COVID-19 has ushered in a new set of challenges for employers, but leveraging SDOH analysis can help mitigate those obstacles. Although there has been a surge in COVID-related patient care, we have also seen a significant decrease in disease management and elective care, which has a negative impact on employee baseline health and wellness.

Think about all the routine low back pain or diabetes follow-up that was skipped or deferred in 2020 because of COVID-19 fears or appointment scarcity. Employers need to select health care plans offered by payers who are prepared for 2022 – when we as a country will return to a new normal and there will be a surge of workers seeking care that they postponed for more than a year because of the pandemic.

With that scenario in mind, employers will need payer plans that have incorporated design opportunities to know how to support their employees where they need it most. Specifically, the next 12-18 months will be a period shaped by these new social determinant needs. Experts anticipate a burst of new disease treatments put off during COVID-19 and new episodes of worsening disease because of skipped care appointments during 2020.

Beyond COVID-19, there are other reasons why employers must pay more attention to SDOH. First, ongoing racial inequality of care in medicine and uncertain U.S. health care legislation in the aftermath of the presidential election create a more precarious environment for employee productivity and retention. This has led to spikes in mental illness and disease morbidity. This surge will likely create more challenges for large and small employers alike. They will bear the burden of navigating these uncharted grounds if they remain on older, nonflexible medical plans.

As SDOH sheds light on unknown socio-clinical variabilities across populations, employers need to be informed on the SDOH capabilities in their policies and should use this new benefit to find new ways to serve their company labor force.  With COVID, we have seen the rise of remote work with people moving out of cities to more rural areas and quieter suburbs.  Employers often have no idea where their workers are living and working in this new post-COVID world.  Employers must adjust their offerings to better care for their workers’ increasingly diverse geographical needs and SDOH can help them get a head start on doing so.

By using SDOH data, Employers will find that knowledge is power – and having greater awareness around key social risks helps them make better strategic decisions both in the short and long term for their employees. They can rely on SDOH to inform their chosen employee support programs while addressing cost and care variations. All of these will help remedy disparity of care, improve value and wellness outcomes, and optimize workforce productivity, which affects the corporate bottom line.

Finally, SDOH can uncover key insights for employers that will help them navigate an even more challenging year ahead. Those insights are:

• Uncovering more value-based care partner opportunities and the best ways to leverage them.
• Finding untapped explanations of the variations in cost of care to drive improved positions when negotiating with payers on contract costs.
• Understanding how clinical risks have far less impact on morbidity and mortality than their employees SDOH risks. This knowledge will help reduce long-term costs for employers.
• Choosing the right collaborative community program remedies to support their employee populations. SDOH will help employers determine the right partnerships and execution strategies to achieve the more successful outcomes.
• Finding the right corporate social responsibility and charitable endeavors that support both their business objectives and the communities they serve. If employers do not commit to a sustained and serious effort in this area, there could be a backlash from both current and future employees and community leaders.

Ultimately, the use of SDOH will help employers improve employee health and well-being, boost both employee satisfaction and increase the overall productivity of the workplace.  This will not only enable employers to be ready to navigate a difficult year ahead, but also put them on the right path to tackle 2022 – when new challenges and potential opportunities await on the horizon.

Ryan Bosch, MD, is president of Socially Determined, a health care technology and analytics company focused on measuring the impact of the social determinants of health. He may be contacted at [email protected].

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