Innovation Closes Care Gaps for Critically Ill Patients | Managed Healthcare Executive

When the venerable Kaiser Foundation Health Plan recently unveiled a Food for Life program, it set an aggressive pace for payers to account for Social Determinants of Health (SDoH), such as food insecurity. The Kaiser program, a multi-pronged social needs initiative set to launch in 2020, is designed to increase healthy food supplies for Kaiser Permanente members by connecting them with underutilized resources. Kaiser recognizes that food deficits are a significant barrier to health, because when people are hungry, lack proper nutrition, or have limited access to the right types of food, medical conditions arise or deteriorate, resulting in avoidable medicalization. 

Identifying members burdened by social and economic challenges has become highly important to achieving optimal member care coordination. In fact, CMS now allows Medicare Advantage and Part D plans to offer supplemental benefits to specifically address SDoH issues.

This increased awareness has prompted health plans and at-risk provider entities, like accountable care organizations or delegated medical groups, to address SDoH and the myriad of non-clinical issues facing members, regardless of their socioeconomic status. Along with focused attention to clinical matters, they are now beginning to understand that these non-clinical concerns, such as food insecurities, transportation challenges, housing problems and even social isolation, are magnified exponentially for individuals and their caregivers facing serious illness and living at home.

Even the most mundane, non-clinical household problems or unexpected events associated with daily living can be overwhelming for these vulnerable patients and their families. Left unattended, these non-clinical issues can create critical gaps in care that often compromise the overall healthcare experience and give rise to unplanned care, overmedicalization and higher costs. These results highlight the need for payers to provide seriously ill members with greater home-based support and increased attention to care coordination that accounts for SDoH and non-clinical problems.

These examples illustrate what can happen when seemingly small challenges snowball into a catastrophic health-related event, resulting in suboptimal outcomes and  significant healthcare expenditures:  a non-working refrigerator can lead to a plan member with advanced diabetes being non-adherent with insulin because there is no place to store it, resulting in complex health problems and high ER utilization; a member who may feel isolated and alone falls into depression, which can impact overall health and increased suicide rates; or a member without a car may not be able to get to physician appointments, medications, and other necessities, which will result in ED visits.

Importance of community-based palliative care for effective care coordination

Traditionally, discussions around care coordination referred to the deliberate organization of patient care activities between two or more participants (including the patient) involved in a patient’s care to facilitate the appropriate delivery of healthcare services. As care needs become more complex, the number of potential participants and relationships among participants tends to increase.