COVID-19 has increased the healthcare industry’s focus on the importance of addressing risks and needs related to social determinants of health (SDOH), especially for people in vulnerable communities or those who are otherwise at higher risk for adverse health outcomes. The ongoing public health emergency spurred by COVID-19 resulted in a rise of unemployment, housing and food insecurities, transportation barriers, and isolation, all of which are SDOH-related risks that can negatively affect a person’s health, result in adverse outcomes and increased utilization (e.g., emergency department visits), and contribute to growing healthcare costs. The pandemic has also exacerbated and magnified existing racial and ethnic health disparities. Along with their increased exposure and susceptibility to COVID-19, Black, indigenous, and other historically marginalized minority populations have poorer overall health outcomes, are less likely to have health insurance, and use or have access to fewer preventative services.
The pandemic has highlighted key challenges with unstructured approaches for addressing SDOH-related risks and needs in clinical settings. There is a lack of consistency in assessing these risks and needs at the point of care and a lack of standardization in measuring successful interventions. There are also challenges with healthcare providers’ ability to identify available resources and share information with community-based organizations that are best-suited to help address these issues.
Value-based payment programs (VBP) offer a solid opportunity for payers and providers to test new ways of providing care that better address SDOH-related risks and needs. According to the Centers for Medicare and Medicaid Services, “Value-based programs reward healthcare providers with incentive payments for the quality of care they give to people with Medicare. VBPs help us move toward paying providers based on the quality, rather than the quantity of care they give to patients.”
Public and private payers alike have demonstrated an ongoing commitment to addressing health disparities and equity through VBPs. Most recently, CMS and the Centers for Medicare and Medicaid Innovation (CMMI) issued significant statements on the importance of advancing health equity to their 10-year vision for CMMI and to driving innovation in programs that address behavioral health and SDOH.