Analytics to help understand social determinants can improve care, boost revenue

Factors such as income security, literacy and social isolation are some of the many social determinants of health – key personal factors that can greatly inform a patient’s overall health outcomes and quality of life.

Understanding and working to improve the SDOH for patients has long been an important part of increasing overall population health, but a new report looks at how they can inform a more streamlined and compressed payment cycle as well.

Matt Hawkins, CEO of Waystar, a cloud-based revenue cycle management compay, says a more granular understanding patients’ social determinants will give providers greater insight into everything from how better to develop a care plan to how to approach billing and payments.

Currently, much of that data is gathered through either self-reporting or through clinician notes. Waystar has found that a large amount of the most of patients who need it most have never spoken to a provider about their social factors, and even one in five of the healthiest patients experience at least some SDOH risk.

By leveraging predictive analytics, with some help from machine learning, IT vendors such as Waystar are able to add better context to information already known about a patient – their address, for instance – that can have a big bearing on their clinicians have a greater ability to structure the way that they provide care.

“It’s one thing that a person lives on 100 North & State Street for instance,” Hawkins says. “It’s another to know it’s an apartment building that doesn’t have an elevator and is four stories high.”

That information – along with other data points, such as whether a patient owns his or her own car or relies on public transit – would greatly speak to how a provider might want to go about delivering care.

Reimbursement, payment and quality of care are all tightly interconnected. Providers want to offer the best care possible and at the same time cut down on unnecessary or wasteful spending and be able to collect payment with the fewest troubles.

Simple things like calling a patient to remind them of an appointment or to take their meds, or ensuring they have adequate transportation to and from the exam room, can have a positive impact on outcomes and costly readmissions. Additionally, understanding that each patient has his or her own social determinants is critical to improving the quality of care.

Hawkins sees gaining better SDOH insights through predictive analytics as a way to spot these challenges and address them before they become barriers to care or payment: “The provider is responsible more and more for the total health of patient, not just a single episode,” he said. “Understanding SDOH can really help understand that patient. All of that would inform how you care for that patient from a clinical perspective and what you can do to make patients life easier from financial perspective.”

Benjamin Harris is a Maine-based freelance writer and and former new media producer for HIMSS Media.
Twitter: @BenzoHarris.

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