A community’s health is determined by much more than the quality of its physicians and hospitals. Other determinants such as access to healthy food, transportation, quality housing, and education can impact life expectancy, morbidity, and chronic conditions.
Nonprofits and government entities are working to address these issues, but what role do employers and private entities have in improving these social determinants of health? Employers pay for around half of all healthcare in the United States, and their taxes help fund the social safety net that provides health to the greater community.
A study from the University of Texas health systems shows that just two miles can translate to an increase of 26 years of life expectancy in Dallas, including an interactive map that shows how life expectancy changes between ZIP codes. Within each ZIP code, it allows users to see life expectancy differences between male, female, black, white, and Hispanic residents. In Dallas, ZIP Code 75204 in Old East Dallas is the area with the most longevity, where men live to be 90.1 years old on average. Just two miles south in ZIP Code 75215 in South Dallas, men are expected to live just 63.6 years, according to the study.
Traditionally, community-based organizations and healthcare providers have not collaborated well with employers and private entities. However, there are some pilot programs to develop relationships between healthcare organizations and private industry. Locally, the Parkland Center for Clinical Innovation has launched the Connected Communities of Care, whose mission is to “a local ecosystem comprised of health systems, payers, community-based organizations (CBO), philanthropic organizations, and local municipality officials to coordinate services that span the clinical-to-non-clinical continuum. The aim of a CCC is to improve the health, safety, and well-being of a community’s most vulnerable residents and to do this in a coordinated, cost-effective, and sustainable manner.”
As networks like this begin to develop, organizations will be able to measure their impact on the community’s health. “As these collaborations become cemented and as a ‘return on investment’ can be regularly demonstrated, then government and payers will have the assurance they need to financially sustain these programs addressing social barriers and disparities,” says Dr. Salil Deshpande, the chief medical officer for UnitedHealthcare Community Plan of Texas.
So what can employers do to address social determinants of health amongst their employees and the community? Part of the answer can be working with their health insurer to identify needs. UnitedHealthcare uses predictive analytics to improve well-being and address social determinants for plan members. The system identifies people in need of support and helps connect them to their needs, such as access to nutritious food or affordable housing. The program uses de-identified claims data from more than 100 million UnitedHealthcare members, and UnitedHealthcare call center advocates contact the members to connect them with community resources.
Employers can also use their claims data to implement healthcare strategies responsive to their employees’ needs and proactively identify the need for support outside of the traditional healthcare needs, as UnitedHealthcare does in partnership with employers and Optum.
Targeted efforts like this address the needs of employees and the community and prevent downstream healthcare costs that the employer ends up paying for through health insurance claims. Providing transportation, housing, or access to food can avoid the costly and preventable health costs that cause unsustainable rising healthcare costs for employers and the system. Community members can often be connected to low or no-cost options to address needs identified by members who say things like “I’m hungry,” “I’m having trouble making ends meet,” or “I’m stressed.”
What are some other strategies employers can use to address holistic health in their employees? Deshpande says these strategies can make an impact:
- Evaluate your current benefits plan design for opportunities to implement a care program that evolves with the patient over time – for example, making chiropractic care or physical therapy mandatory for back disorders before moving to more aggressive treatments.
- Cover medications as preventive care for specific chronic conditions or promote patient assistance programs for specific types of medications. The latter may require exclusion of some medicines from your benefit plan design.
- Institute an exercise, stretch or meditation program at the beginning of work shifts to improve safety and decrease injuries. These types of practices are preventive and may decrease the severity of an injury if one occurs.
- Create targeted communications for specific regions and demographics. Consider sharing success stories or appointing a program champion from the target audience. Understand and reflect on cultural differences when developing each communication.
- Promote virtual care to improve access to treatment for specific conditions – for example, mental health support in rural areas.
- Work with your third-party administrator or medical expert(s) to identify opportunities for provider outreach and education on best-in-class approaches.
- Employers can target their social responsibility activities and employee volunteer efforts with those community-based organizations who directly address some of the more commonly identified social barriers. For example, volunteer efforts can center on addressing food insecurity through efforts at a local food bank, or on addressing housing instability through efforts supporting a local homeless shelter.