Module #7:Caring For Your Health Tool on the Social Determinants of Health: Return On Investment For more information on TCPI SANs please use this link: http://www.tcpisan.org/

HCDI Overview HCDI-SAN Learning Library: Overview CFYH Tool ROI HealthCare Dynamics, International – founded and led by clinicians 25+ years supporting CMS quality and population health programs NICHE: Policy to Practice Strategy focused on health care delivery systems and the quality/cost for vulnerable populations Customized learning and action platforms focused on clinicians, patients and health care systems HCDI-SAN Learning Library: Overview CFYH Tool ROI Present examples and scenarios demonstrating the Return On Investment (ROI) opportunities associated with including Social Determinants of Health(SDoH) into your patient health care profile The move to value-based care is evolving from diagnosis and treatment to community-based patient engagement

Learning Objectives: HCDI-SAN:Caring For Your Health Tool on the Social Determinants Of Health: Return On Investment Upon completing review of this slide-deck presentation, participant will able to: Identify “Gaps” in care related and contributable to the Social Determinants of Health Describe the influence of the Social Determinants of Health in determining an individuals continuing health care status Define the possible Return On Investment associated with addressing the Social Determinants of Health Articulate the financial barriers to investigating the Social Determinants of Health Understand the significance and impact of Population Health Management

HCDI-SAN: Caring For Your Health Tool on the Social Determinants Of Health: Return On Investment What is ROI? Unlike a cost-benefit analysis, which looks at both the financial and non-financial benefits of a new project, ROI is purely a financial exercise to ascertain the financial return of a specific dollar investment. Typically, the goal is to identify a tangible metric (such as hours saved), and calculate this metric into a precise financial return (such as dollars saved or dollars made).

HCDI-SAN: Caring For Your Health Tool on the Social Determinants Of Health: Return On Investment Some of the numbers: For the first time, SDoH made the 2018 list of top health care industry issues published annually by PwC Health Research Institute. Social determinants earned their ranking because the United States currently spends nearly 18% of GDP on health care, and that is heading to just under 20% by 2026, according to Centers for Medicare & Medicaid Services actuaries. Just about everyone agrees that is unsustainable—and unjustified in light of the country’s poor health outcomes compared with those of other developed nations. Other developed countries simply do a better job of keeping their vulnerable populations healthy. For every dollar spent on health care, the U.S. spends 56 cents on social services such as housing support or cash assistance for the poor and elderly. Other developed countries spend $1.70 on social services for every dollar spent on health care.

HCDI-SAN: Caring For Your Health Tool on the Social Determinants Of Health: Return On Investment After implementing the HCDI-SAN Caring For Your Health Tool on the Social Determinants Of Health, what is your potential ROI? Decades of research have demonstrated that economic stability, physical environment, education, food, and social context are powerful upstream factors that largely determine one's health before the health system is able to intervene. Social determinants of health also influence the effectiveness of medical interventions. For Example: Antibiotics are of little help to those who drink polluted water every day.

HCDI-SAN: Caring For Your Health Tool on the Social Determinants Of Health: Return On Investment Trend versus reality when addressing SDoH: As population health professionals look for new ways to enhance their stewardship of vulnerable populations, many are actively collaborating with community service providers. This trend is center stage across the healthcare landscape where addressing SDoH and is frequently discussed as a strategy to improve patient care and drive better financial results. Unfortunately, reality doesn’t reflect this trend: More than 72% of hospitals still do not have a dedicated budget to support population health initiatives. Two-thirds of hospital electronic medical records do not screen for patient’s social and behavioral needs.

Overview: Social Determinants of Health SDoH also refers to the bigger set of forces that shape the conditions of daily life of an individual. These forces can be social norms, culture, social practices, economic policies, developmental agendas along with political systems of any state/nation SDoH are considered as the root cause of our health and disease. Often times it is also known as the ‘cause of the cause’.

HCDI-SAN: Caring For Your Health Tool on the Social Determinants Of Health: Return On Investment What’s the problem? There is a growing body of evidence, both data-driven and anecdotal, that targeting solutions for social determinants of health in a provider's community yields positive results in improving outcomes, cutting readmissions and facilitating better management of chronic illness. Despite this evidence, health systems still hesitate to invest in programs that seek to address these issues and significant funding is rare. The belief is that because these studies/programs that deal with SDoH are considered "public goods," their return on investment is harder to quantify. A financial model that might enable more investment includes focusing on these programs as being in the provider's "self-interest," making them an investment, not a donation. This effect has been dubbed the "free-rider problem."

HCDI-SAN: Caring For Your Health Tool on the Social Determinants Of Health: Return On Investment What’s the problem (Cont.)? The simple answer is competing priorities and limited funding. Because healthcare is in constant state of change, new approaches, innovative technologies, and improved processes continually compete for budget. Individual healthcare organizations find it challenging to accurately estimate the "full net benefit" of their investments in such programs due to a lack of good data on relevant costs and benefits. Healthcare organizations might not be sure if or how social services would be delivered to the target group, since that work is done outside the hospital by non-healthcare personnel. Sufficient funding is rare and providers hold back on investing in such programs due to the inability to quantify benefits.

HCDI-SAN: Caring For Your Health Tool on the Social Determinants Of Health: Return On Investment Return On Investment General Example(s): A recent study published by WellCare Health Plans and the University of South Florida College of Public Health found that connecting people to social services through a hotline led to a 10 percent reduction in healthcare costs compared to a control group. This amounted to more than $2,400 in annual savings per person through a low-tech intervention that was more about re-distribution and re-organization than new infusion of capital. Montefiore Health System in the Bronx has tackled the social determinants of health by investing in housing, a move that has cut down on emergency room visits and unnecessary hospitalizations for an annual 300 percent return on investment. This has positively impacted the spending trends, and resource availability of the Montefiore Health System

HCDI-SAN: Caring For Your Health Tool on the Social Determinants Of Health: Return On Investment Return On Investment General Example(s): A good example was in Hawaii, where state Sen. Josh Green, MD, last year introduced a bill that would require all insurers, including Medicaid managed care plans, to cover “the treatment of homelessness.” Green, an emergency physician, called homelessness a health condition as a way to get people’s attention—and because he believes it. “You could say this is the ultimate social determinant of health,” Green said. Green was tired of the routine: Homeless patients arrive in the emergency room via ambulance because they have no transportation. Doctors address their immediate needs, often with an expensive inpatient stay, but when patients return to the streets, their health starts to deteriorate again. He points to a Hawaii pilot that placed homeless people in housing with supportive services—and watched their medical costs drop 43% within six months.

Return On Investment HCDI-SAN Example HCDI-SAN: Caring For Your Health Tool on the Social Determinants Of Health: Return On Investment Return On Investment HCDI-SAN Example

HCDI-SAN: Caring For Your Health Tool on the Social Determinants Of Health: Return On Investment Investing in the social determinants of health is becoming more commonplace even as hospitals and physicians ask whether it is their place to step outside of traditional care to not only look at, but try to fix, other reasons that keep patients from getting better. Value-based care and managed care has spurred many to realize that food insecurity, isolation, lack of housing and other factors must be addressed in their populations for continuity of care to succeed as a real goal. For many hospitals, buying food and investing in housing becomes less expensive than having a patient return to the emergency room numerous times a year. 

Learning In Action: “Food For Thought” How might having data on potential CFYH Tool ROI affect how your office provides care? What is your experience with improving the ROI of your practice? Do you think that SDoH (i.e. food insecurity, transportation, literacy) are affecting your practice's bottom line? What is your potential ROI once SDoH are identified and accounted for?

Questions? Uchenna Okoli SDoH@hcdi.com 301-552-8803 www.hcdi.com For more information on TCPI SANs please use this link: http://www.tcpisan.org/ 18

Learning & Action Network Acronym Guide: AAPM: Advanced Alternative Payment Models APM: Alternative Payment Models CEHRT: Certified Electronic Health Record Technology CFYH Tool: ‘Caring for Your Health’ Social Determinants Indicator Tool CMS: Centers for Medicare & Medicaid Services HCDI: HealthCare Dynamics International LAN: Learning and Action Network MACRA: Medicare Access and CHIP Reauthorization Act MIPS: Merit Based Incentive Payment System PTN: Practice Transformation Network QPP: Quality Payment Program REaL Data: Race Ethnicity and Language Data SAN: Support and Alignment Network SDoH: Social Determinants of Health TCPI: Transforming Clinical Practices Initiative